When it comes time for the annual Medicare open enrollment period (Oct. 1-Dec. 7), one type of plan you might hear about is a Medicare Advantage Special Needs Plan (SNP). This is a type of Medicare Advantage plan for people with additional health needs, often due to a specific severe and chronic disease such as diabetes or dementia. SNPs are also available to people who qualify for both Medicaid and Medicare.
The plans are commonly considered: More than 7 million people on Medicare were enrolled in one in 2025, according to KFF, a nonprofit health policy research, polling, and news organization.1
SNPs offer care coordination and tailor benefits, doctors, and covered medications to meet the specific needs of the people enrolled. This is important for anyone experiencing specific severe and chronic diseases, but especially for older adults, (including the large baby boomer generation born from 1946 to 1964), who are living longer and becoming a larger percentage of our population, according to the United States Census Bureau.2
And the older you are, the more at risk you become for certain chronic conditions. But SNPs can also be tricky to figure out. Her's what you may want to know.
If you think you may be eligible for a Medicare Advantage Special Needs Plan (or SNP), it’s easy to get the information you need from a licensed insurance agent. Call one at 866-934-0216 to discuss your options.
What is a Medicare Special Needs Plan?
A Special Needs plan is a type of Medicare Advantage Plan available only to people who have certain qualifying health conditions or situations. For example, if you have heart disease or live in a nursing home — or if you qualify for both Medicare and Medicaid — an SNP may be something to consider.
There are 3 types of SNPs, that provide care coordination, tailored benefits, and maybe even coverage for extra services to meet the specific needs of the groups they serve.
Who can join an SNP?
Anyone who is eligible for Medicare Part A (hospital insurance) and Medicare Part B (health insurance), lives in the plan’s service area, and meets the eligibility requirements can join an SNP.
What are the different types of SNP plans and eligibility requirements?
There are 3 types SNPs, and to be eligible to sign up, enrollees must meet the qualifications for at least one of these:
Chronic Condition SNP (C-SNP). About 16% of SNP enrollees are in these plans1, which are for people with at least one of these chronic conditions:
- Alcohol or other drug dependence
- Autoimmune disorders, including rheumatoid arthritis and systemic lupus erythematosus (SLE) (not all autoimmune conditions qualify)
- Cancer (excluding pre-cancer conditions)
- Cardiovascular disorders, including coronary artery disease
- Chronic heart failure
- Dementia
- Diabetes
- End-stage liver disease
- End-stage renal disease (ESRD) requiring dialysis (hemodialysis or peritoneal dialysis)
- Severe blood disorders, including hemophilia and sickle-cell disease
- HIV/AIDS
- Chronic lung disorders, including asthma and emphysema
- Chronic and disabling mental health conditions, including bipolar disorders and major depressive disorders
- Neurologic disorders, including epilepsy, multiple sclerosis and Parkinson’s disease
- Stroke
Institutional SNP (I-SNP). You live in, are expected to live in for at least 90 days in a row, or need the level of care offered by a qualifying institutional facility. About 2% of enrollees are in I-SNPs.1
Dual Eligible SNP (D-SNP): You have both Medicare and Medicaid. This is the most common SNP, with about 83% of enrollees in these plans.1 People with D-SNP can receive support in coordinating their Medicare plan with Medicaid benefits, since it can be confusing to work through all the details.
If you’re on Original Medicare and looking to switch to a Medicare Advantage plan, you have some options. Call a licensed insurance agent at 866-934-0216 to talk about the pros and cons of switching.
How does a Medicare SNP work?
SNPs are a type of Medicare Advantage (MA) plan offered by private insurance companies approved by Medicare. All MA plans must provide you with the same benefits as Original Medicare Part A and Part B, but they often offer additional benefits not offered by Original Medicare. SNPs tailor their benefits to meet the needs of their population. This includes:
A care coordinator. This person will help you stay healthy and follow your doctor’s orders. For example, a care coordinator for a person with diabetes on a C-SNP might help them monitor their blood sugar, eat right and exercise, and schedule preventive services such as regular eye and foot exams. If you have a D-SNP, your care coordinator may help you access community resources and schedule transportation to doctor appointments.
Specialized care. SNPs are designed to provide benefits and services for people with specific severe and chronic diseases, and certain healthcare needs. For example, if you have type 2 diabetes, you may choose a C-SNP that includes tailored benefits around:
- Blood sugar (glucose) and insulin management tools
- Dental, hearing and vision care
- Routine foot care
Medicare Advantage plans that are not SNPs provide benefits but do not tailor them to a specific severe or chronic disease. The tailored plan benefits may help you manage certain healthcare needs for a chronic illness.
Prescription drug lists (formularies) tailored to your condition. The prescription drug plans for SNPs are designed with a specific chronic disease treatment plan in mind. That means the formulary (list of covered drugs) is tailored to the most common medications prescribed to manage a chronic condition. For example, someone with a condition such as congestive heart failure or asthma would typically see a broader number of medications to treat that specific issue in an SNP’s formulary.
How much do SNP plans cost?
That depends. Medicare Advantage Organizations determine the amount of monthly premiums, deductibles, coinsurance and copays for the plans they offer, including SNPs.
If a MA SNP offers additional benefits not included in Original Medicare Part A and Part B, it may mean paying a little more each month. But if you’re on a D-SNP plan, there are no deductibles or copays if you stay in network.
In addition, SNPs can’t impose higher copayments or coinsurances than Original Medicare charges for certain kinds of care, including chemotherapy, dialysis and skilled nursing facility (SNF) care. But SNPs can charge higher copays for other services, including home health, durable medical equipment (DME) and inpatient hospital care. All SNPs are required to provide Medicare Part D coverage.
Can I get my healthcare from any doctor or network?
Usually, you need to stay in the SNP provider network to avoid paying higher cost sharing amounts. An SNP’s network includes providers who treat the specific needs or conditions of their population. There are 2 exceptions:
- Emergency or urgent medical care
- If a person has end-stage renal disease and needs out-of-area dialysis
If you have an SNP, getting care within your SNP’s network can help reduce out-of-pocket costs but may require a referral to see a specialist.
What questions should I ask before I enroll in an SNP?
Just as you would do before joining any plan, your questions should be geared toward your individual healthcare needs. Here are some examples of things to ask to help you narrow down your choices.
- How do the SNP’s benefits compare with other plans available?
- What benefits does the SNP provide that will help with my special needs? For example, which benefits are included to help me manage a chronic condition?
- What costs — premiums, deductibles and copayments — should I expect for my coverage?
- Is there an annual limit on my out-of-pocket costs for covered expenses?
- Are my doctors in the plan’s network?
- If I join an Institutional SNP, will the plan’s network include my nursing home or home health services?
- Am I ever allowed to go out of network?
- Do I need a referral to see a specialist?
- Are my prescriptions on the plan’s covered list of drugs?
Can I lose my SNP plan?
Yes. You can only stay enrolled if you continue to meet the special eligibility rules for the SNP. For example, if you are enrolled in a D-SNP and were no longer eligible for Medicaid, the insurance company will notify you that you no longer qualify for an SNP.
A change in your Medicaid status makes you eligible for a Special Enrollment Period. Your chance to enroll in another Medicare Advantage plan or return to Original Medicare, lasts for 3 full months from either the date you're no longer eligible or the date you're notified you're no longer eligible, whichever is later.
For informational purposes only. This information is compiled by HealthMarkets Insurance Agency and does not diagnose problems or recommend specific treatment. Services and medical technologies referenced herein may not be covered under your plan. Please consult directly with your primary care physician if you need medical advice.
