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Understanding Special Need Plans

Special Needs Plans (SNPs) were established by Congress through the Medicare Modernization Act of 2003. Since then, Congress has continued to reauthorize these specialized plans. The program has grown by over 60% and now represents 12.5% of Medicare Advantage. Special Needs Plans (SNPs) are a type of Medicare Advantage plan tailored to serve high-cost, high-need beneficiaries.

The primary three types of Special Needs Plans are (1) Dual-Eligible SNPs (D-SNPs), which serves beneficiaries eligible for coverage under both Medicare and Medicaid, known as dual-eligible beneficiaries. (2) The Chronic Condition SNPs (C-SNPs) which serves beneficiaries with a disabling chronic condition, such as End Stage Renal Disease (ESRD), severe diabetes, dementia, or cancer and (3) Institutional SNPs (I-SNPs) that serves institutionalized beneficiaries residing in a long-term care facility, such as a Skilled Nursing Facility, or living at home but requiring an institutional level of care.

Medicare Advantage Special Needs Plans include all Medicare Part A, Part B, and Part D benefits. Also, may include other services to beneficiaries depending on specific health status or quality of life. SNPs members usually have specialists tailored to focus on supporting their specific condition.

As of 2017, over 2.4 million beneficiaries are enrolled in nearly 600 SNPs nationwide.
Different types of SNPs may be available for different parts of the country. Every state or/and county decides what is available for their beneficiaries. Benefits and costs vary depending on area and insurance company. Some counties might offer a selection of Special Needs Plans through insurance companies if they have created that business opportunity. Parts of the country do not have access to these types of plans.

One of the biggest benefits of SNPs include ‘Model of Care’ (MOC) were the Centers for Medicare & Medicaid Services (CMS) requires approval by the National Committee for Quality Assurance (NCQA) for each Special Need Plan. MOC is a quality improvement tool that makes SNPs unique because they ensure the needs of each beneficiary enrolled are identified and addressed.

The main difference between a Medicare Advantage plan and a SNP are the tailored benefits and care delivery models that are provided to the specific populations SNPs serve. Better Medicare Alliance wants to ensure that beneficiaries understand and get more access to information on SNPs. As of this year, Congress has permanently authorized the special needs plan and we will continue to advocate for more access to beneficiaries around the country that can benefit from the enrollment in SNPs.

Learn more by watching the video below.