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.
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.