What is a Special Needs Plan?
A Special Needs Plan (SNP) is a Medicare Advantage (MA) coordinated care plan (CCP) specifically designed to provide targeted care and limit enrollment to special needs individuals. A special needs individual could be any one of the following:
- An institutionalized individual;
- A dual eligible, or;
- An individual with a severe or disabling chronic condition, as specified by CMS.
A SNP may be any type of MA CCP, including either a local or regional preferred provider organization (i.e., LPPO or RPPO) plan, a health maintenance organization (HMO) plan, or an HMO Point-of-Service (HMO-POS) plan. There are three different types of SNPs:
- Chronic Condition SNP (C-SNP)
- Dual Eligible SNP (D-SNP)
- Institutional SNP (I-SNP)
- Medicaid Eligibility Categories
The Medicaid eligibility categories encompass all categories of Medicaid eligibility including:
- Full Medicaid (only)
- Qualified Medicare Beneficiary without other Medicaid (QMB Only)
- QMB Plus
- Specified Low-Income Medicare Beneficiary without other Medicaid (SLMB Only)
- SLMB Plus
- Qualifying Individual (QI)
- Qualified Disabled and Working Individual (QDWI)
States may vary in determining their eligibility categories; therefore, there may be state-specific differences in the eligibility levels in comparison to those listed here.
- D-SNPs and Healthy Connections Medicaid
Dual Eligible Special Needs Plans (D-SNPs) enroll individuals who are entitled to both Medicare (title XVIII) and medical assistance from a state plan under Medicaid (title XIX). States cover some Medicare costs, depending on the state and the individual’s eligibility.
Note: The list above includes all populations defined by CMS as potential populations who may be eligible for the D-SNP program. The South Carolina Department of Health and Human Services State Medicaid Agency Contract (SMAC) defines the current eligible population.
- Resources
The Centers for Medicare and Medicaid Services (CMS) maintains regulating authority for the Special Needs Plan coverage model. For more information regarding SNPs, please visit the CMS Resource Center.
Additional information regarding all SNP types can be found in the Medicare Managed Care Manual; Chapter 16B.
Choosing the coverage that is right for you.
There are a multitude of coverage options available for members who are dually eligible and receive health coverage from both Medicare and Healthy Connections Medicaid. The Coverage Model Comparison is designed to help navigate key distinctions between those programs.
Note: Not all individuals have the same needs or meet the same eligibility criteria. Program eligibility may vary.
How to Enroll
Enrollment into Medicare and Healthy Connections Medicaid are handled by separate entities.
Getting Medicare
For D-SNP and other Medicare-related enrollment questions, members should contact Medicare directly by visiting www.medicare.gov or by calling 1-800-MEDICARE (1-800-633-4227).
Getting Healthy Connections Medicaid
Members inquiring about Healthy Connections Medicaid have multiple options for enrollment and enrollment-related questions. Members should contact the South Carolina Department of Health and Human Services (SCDHHS) via telephone, fax, or by visiting local county offices. Information on how to contact SCDHHS regarding enrollment and more can be found in the Members section of the website.