Medicare Advantage SNP Plans

Medicare Advantage SNP Plans

What are Medicare Advantage SNP Plans?


Medicare Advantage Special Needs Plans (SNPs) are a type of Medicare Advantage Plan specifically designed to provide targeted care for individuals with unique health or financial needs.


These plans must cover all the services included in Original Medicare (Part A and Part B), but they can also include additional benefits tailored to the group they serve. SNPs typically provide a highly coordinated care approach, with a care team to ensure that all of the beneficiaries' healthcare needs are met. There are three types of SNPs:


Chronic Condition SNPs (C-SNPs): for people with specific chronic diseases.


Dual Eligible SNPs (D-SNPs): for those who qualify for both Medicare and Medicaid.


Institutional SNPs (I-SNPs): for individuals who live in institutions (like nursing homes) or who require nursing care at home. Like other Medicare Advantage plans, most SNPs also include prescription drug coverage.


Individuals considering an SNP should ensure they qualify for the specific type of SNP, and that the plan's network of providers suits their needs.

Eligibility For Medicare Advantage SNP Plans

The eligibility criteria for Medicare Advantage Special Needs Plans (SNPs) are quite specific. Here they are:

  1. Medicare Eligibility: You must be eligible for Medicare, which typically means you are 65 or older, or you are under 65 with a qualifying disability or condition.
  2. Medicare Part A and Part B Enrollment: You need to be enrolled in both Part A (hospital insurance) and Part B (medical insurance) of Original Medicare.
  3. Residency: You must live in the service area of the SNP plan you want to join.
  4. Specific Conditions or Circumstances: Each SNP plan serves a specific group of people. So, you must meet the particular conditions or circumstances that the plan is designed to serve:
  • Chronic Condition Special Needs Plans (C-SNPs): These serve beneficiaries with certain severe or disabling chronic conditions. The list of conditions can vary from plan to plan, but they could include diseases like diabetes, end-stage renal disease (ESRD), HIV/AIDS, chronic heart failure, dementia, and others.
  • Dual Eligible Special Needs Plans (D-SNPs): These plans are for individuals who are eligible for both Medicare and Medicaid.
  • Institutional Special Needs Plans (I-SNPs): These plans serve individuals who live in an institution (like a nursing home) or those who require nursing care at home.


Enrollment Periods for Medicare Advantage SNP Plans

Enrollment periods for Medicare Advantage Special Needs Plans (SNPs) follow the same general rules as other Medicare Advantage plans. Here's an overview:

  1. Initial Enrollment Period (IEP): This is when you first become eligible for Medicare. It begins three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65. If you're under 65 and eligible for Medicare due to disability, your IEP starts three months before your 25th month of disability and ends three months after your 25th month of disability. During the IEP, you can enroll in a Medicare Advantage SNP if you're eligible.
  2. Annual Election Period (AEP): Also known as Open Enrollment, the AEP runs from October 15 to December 7 each year. During this time, you can change your Medicare Advantage plan, switch from Original Medicare to a Medicare Advantage plan, or vice versa. If you're eligible, this is also when you can enroll in a SNP.
  3. Medicare Advantage Open Enrollment Period (MA OEP): From January 1 to March 31 each year, if you're already enrolled in a Medicare Advantage plan, you can switch to a different Medicare Advantage plan or switch back to Original Medicare. This includes the option to switch to a SNP if you're eligible.
  4. Special Enrollment Periods (SEPs): You may be able to enroll in a SNP outside of the usual enrollment periods under certain circumstances, such as if you move, lose your current coverage, or you are eligible for both Medicare and Medicaid. There are many different SEPs, each with its own rules about when you can make changes and what changes you can make.
  5. 5-Star Special Enrollment Period: You can switch to a Medicare Advantage Plan or Medicare Cost Plan that has 5 stars for its overall star rating from December 8–November 30, but only once per calendar year. If you're eligible, you can use this SEP to enroll in a 5-star SNP.


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