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Medicare Advantage Special Needs Plans

What is a C-SNP and I-SNP?

A Special Needs Plan (SNP) is a type of Medicare Advantage plan designed for Medicare beneficiaries who meet certain health requirements, such as those with limited incomes and assets or suffering from a chronic condition like ESRD or those living in a long-term care facility. Like all Medicare Part C plans, SNPs must offer the same rights, benefits, and protections as Medicare Part A and Part B.

Medicare Advantage Special Needs Plans are designed to provide coverage for three specialized groups of patients, which include individuals with a chronic condition (C-SNPs), individuals who are dual-eligible (D-SNP), and institutionalized individuals (I-SNPs). In this article, we’ll be discussing what C-SNP and I-SNP are.

What is a C-SNP?

SNPs can offer health coverage for Medicare beneficiaries with a certain chronic health condition or those suffering from at least one of the many chronic health conditions. Medicare allows private health insurance companies to provide SNPs to Medicare members suffering from these disabling and chronic conditions. These SNPs are known as Chronic Condition SNPs (C-SNPs). The conditions that make an individual eligible for C-SNPs include:

  • Chronic alcohol or other drug dependences
  • Diabetes mellitus
  • Cancer
  • Cardiovascular disorders
  • Stroke
  • Dementia or Alzheimer’s disease
  • Neurologic disorders
  • Chronic, disabling mental health disorders
  • HIV/AIDs
  • End-stage kidney disease (ESRD)
  • Autoimmune disorders
  • End-stage liver disease
  • Chronic heart failure
  • Chronic lung disorders
  • Severe hematologic disorders

Remember that even if you have one of the conditions listed above, you still need to check whether the Special Needs Plan you want to enroll in is provided in your area.

What is an I-SNP?

To qualify for an Institutional SNP (I-SNP), you must have had or need the services provided in specific institutions for a minimum of 90 days. These institutions can include:

  • Long-term care facility
  • Skilled nursing facility
  • Intermediate care facility
  • Inpatient psychiatric facility

As an alternative, a Medicare beneficiary must have met their state’s guidelines for needing home-level nursing care for a minimum of 90 days.

If you have not yet received care for at least 90 days, but you will likely need this level of care for that same period, you can also qualify for I-SNPs.

How Can You Enroll in an SNP Plan?

You must sign up for Original Medicare and qualify for one of the SNPs. You can easily enroll by applying online or contacting Medicare directly.

Keep in mind that you will continue to pay your Part B premium, on top of whatever the premium may be for the plan. Some Medicare Advantage Plans can have a $0 premium, but the average premium is typically around $21.

Do you need more information about Medicare Advantage C-SNPs and I-SNPs? Contact Proinsurance Hawaii to talk to an experienced Medicare expert.