Special Needs Plans (SNPs)
Special Needs Plans (SNPs) are a specialized type of Healthcare Advantage plan designed to support individuals with unique healthcare needs. Availability may vary by region, so not all areas may offer SNP plans.
These plans provide targeted care for individuals with chronic conditions, disabilities, or specific healthcare requirements. SNPs are divided into three categories:
- Institutional SNP Plans – For individuals residing in long-term care facilities.
- Dual Eligibility SNP Plans – For those eligible for both Medicaid and Healthcare.
- Chronic Conditions SNP Plans – For individuals with severe or ongoing health conditions.
Dual Eligible Special Needs Plan (D-SNP)
Dual Eligible Special Needs Plans (D-SNPs) are designed to support low-income individuals who qualify for both Healthcare and state-funded medical assistance, typically through Medicaid. Eligibility criteria may vary depending on the plan and location.
In some states, Medicaid may cover certain Healthcare expenses for D-SNP beneficiaries. These plans offer two cost-sharing options based on the level of financial assistance required:
In some states, Medicaid may cover certain Healthcare expenses for D-SNP beneficiaries. These plans offer two cost-sharing options based on the level of financial assistance required:
- Healthcare Zero-Cost-Sharing Plan – Beneficiaries incur no out-of-pocket costs for covered services.
- Healthcare Non-Zero-Cost-Sharing Plan – Some cost-sharing may apply, depending on the specific services and level of assistance provided.
Chronic Special Needs Plan (C-SNP)
Chronic Special Needs Plans (C-SNPs) are designed for individuals managing severe and complex chronic conditions. These conditions are typically life-threatening, significantly disabling, or require specialized medical care.
Eligible conditions often involve a higher risk of hospitalization, severe complications, or the need for advanced treatment options. Common qualifying conditions include Chronic Obstructive Pulmonary Disease (COPD), Diabetes, and Atrial Fibrillation (AFIB).
C-SNPs help reduce the financial strain of medications and treatments related to these conditions. To enroll, beneficiaries must have their healthcare provider complete a certification form confirming their chronic medical needs.
Eligible conditions often involve a higher risk of hospitalization, severe complications, or the need for advanced treatment options. Common qualifying conditions include Chronic Obstructive Pulmonary Disease (COPD), Diabetes, and Atrial Fibrillation (AFIB).
C-SNPs help reduce the financial strain of medications and treatments related to these conditions. To enroll, beneficiaries must have their healthcare provider complete a certification form confirming their chronic medical needs.
Institutional Special Needs Plan (I-SNP)
Institutional Special Needs Plans (I-SNPs) are designed for individuals who reside in long-term care facilities or require institutional-level care for an extended period.
To qualify for an I-SNP, a beneficiary must have received or be expected to require care in one of the following facilities for at least 90 days:
To qualify for an I-SNP, a beneficiary must have received or be expected to require care in one of the following facilities for at least 90 days:
- Skilled Nursing Facility (SNF)
- Long-Term Care (LTC) Facility
- LTC Nursing Facility (NF)
- Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IDD)
- Inpatient Psychiatric Facility
Meeting these criteria is essential for I-SNP eligibility, ensuring that beneficiaries receive specialized care tailored to their long-term healthcare needs.
How to Appeal an SNP Disenrollment Notice
If you disagree with an SNP disenrollment notice, you have the right to appeal. Your appeal will be reviewed by an independent agency to ensure fairness.
Immediate Review for Hospital Discharges: If disenrollment results in an early hospital discharge, you can request an immediate review from the Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO). The hospital must continue providing care at no cost until the review is complete, and you cannot be discharged until a decision is made.
Expedited Appeals for Other Care Services: Beneficiaries receiving care from skilled nursing facilities, rehabilitation centers, or home health services have access to an expedited appeal process for faster resolution.
Preparing for Your Appeal:
Immediate Review for Hospital Discharges: If disenrollment results in an early hospital discharge, you can request an immediate review from the Beneficiary and Family-Centered Care Quality Improvement Organization (BFCC-QIO). The hospital must continue providing care at no cost until the review is complete, and you cannot be discharged until a decision is made.
Expedited Appeals for Other Care Services: Beneficiaries receiving care from skilled nursing facilities, rehabilitation centers, or home health services have access to an expedited appeal process for faster resolution.
Preparing for Your Appeal:
- Collect medical records or documentation from your healthcare provider that supports your case.
- If your health is at risk, request a fast-track appeal, which generally provides a decision within 72 hours.
Need Help Enrolling in a Healthcare Advantage SNP Plan?
Choosing the right Healthcare Advantage Special Needs Plan (SNP) can be overwhelming, as coverage details vary between providers. Understanding what’s essential versus optional can be challenging—that’s where our expertise comes in.
We’re here to simplify the process for you. Contact us by phone or fill out our online quote form today to explore available Healthcare Advantage SNP options in your area. Our team will guide you through your choices, ensuring you find the best plan for your healthcare needs.
We’re here to simplify the process for you. Contact us by phone or fill out our online quote form today to explore available Healthcare Advantage SNP options in your area. Our team will guide you through your choices, ensuring you find the best plan for your healthcare needs.
