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Medicare Advantage Special Needs Plans

Special Needs Plans (SNPs) are a type of Medicare Advantage plan that is only available to Medicare beneficiaries who meet certain qualifying conditions. They can offer richer benefits than typical Medicare Advantage plans, BUT you must qualify.

Types of Special Needs Plans

There are 3 types of Medicare Special Needs Plans:

Dual Eligible Special Needs Plans (D-SNP)

Dual Eligible Special Needs Plans are for people who are eligible for both Medicare and Medicaid. Each plan will specify a level of Medicaid that is required in order to be eligible, so just because you have Medicaid does not mean you are guaranteed to be approved.

We have a detailed page explaining plans for Medicare and Medicaid.

  • Important!

    Just because you have Medicaid, does not mean you automatically qualify for a Dual Eligible Plan. Check with an expert to see if your level of Medicaid qualifies!

Institutional Special Needs Plans (I-SNP)

Institutional SNPs are for Medicare beneficiaries who are living within an institution. You may qualify for an Institutional SNP if you live in one of the following facilities for at least 90 days straight:
  • Nursing home
  • Intermediate care facility
  • Skilled nursing facility
  • Long-term care hospital
  • Psychiatric hospital

Other facility may also qualify if they offer similar services and have residents with similar needs as the facilities listed above.

In order to apply for an Institutional plan, you will need to submit proof of institutionalization for at least 90 days. In certain circumstances, you could even be approved for an I-SNP if you’re receiving nursing care in a home instead of a facility.

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Chronic Condition Special Needs Plans (C-SNP)

C-SNP plans are available for people with one or more severe or disabling chronic conditions. The following are a list of conditions that may qualify you for a C-SNP plan.

  • End-Stage Renal Disease (ESRD)
  • Dementia
  • Cancer
  • Diabetes
  • Chronic heart failure
  • HIV/AIDS

FAQs

How do I qualify for a Medicare Special Needs Plan?

In order to qualify for a Special Needs Plan, you must meet the criteria of the plan:

  • Dual Eligible: Have Medicare and a qualifying level of Medicaid
  • Institutional: Be living in an institution for at least 90 days.
  • Chronic Condition: Have a severe and/or disabling condition such as dementia and Cancer.

Summary

Medicare Special Needs Plans are a great option for those who meet the criteria. If you have certain chronic diseases, live in an institution, or have Medicaid, it may be worth checking to see if you are eligible for these benefit rich plans. Schedule an appointment with The Medicare Family today!

Sylvia Gordon, aka Medicare Mama®, is an expert on all things Medicare and Social Security. She is the 2nd Generation here at The Medicare Family and has served on the advisory boards of major insurance companies like UnitedHealthcare®, Cigna, and Anthem. In her free time, she can be found taking care of her animals (dogs, goats, peacocks, chickens), and reading a good book. Learn More.
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