Special Needs Plans

Medicare Advantage Plans offer more flexibility when it comes to coverage for Medicare consumers. There are six different types of Medicare Advantage Plans. A Special Needs Plan (SNP) is one type. An SNP focuses on certain healthcare needs to tailor coverage to individuals with special needs.

SNP Overview

An SNP is a type of plan that tailors itself to specific diseases, healthcare needs, or incomes. The benefits, providers, and drug formularies are all tailored to best meet the needs of the groups they serve. SNPs are targeted at three different groups: people who are institutionalized, people who are dual-eligible for both Medicaid and Medicare, or people who have severe or disabling chronic conditions. Generally, these chronic conditions include diabetes, End-Stage Renal Disease, HIV/AIDS, chronic heart failure, or dementia. 

An SNP can be any type of plan, including a Preferred Provider Organization plan or a Health Maintenance Organization plan. You must fall into one of the three population categories above to enroll in an SNP.

SNP Coverage

Because SNPs are targeted at specific populations, their coverage differs depending on the type of plan. All SNPs provide Part D prescription drug coverage. Some provide out-of-network coverage and others do not. SNPs have less flexibility in that you would need to choose a primary care doctor, and specialist services often require a referral. 

If you believe you fall into a category that could benefit from an SNP, make sure to compare different Medicare Advantage SNPs to understand which plan is right for you. 

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