Enrollment for SNP

What Are Special Needs Plans?

Special Needs Plans (SNPs) are Medicare Advantage plans designed for people with specific health conditions or circumstances.

They provide targeted care coordination and benefits that regular Medicare Advantage plans don't offer.

Three Types of Special Needs Plans

Chronic Condition SNPs (C-SNPs)

These plans serve people with specific chronic conditions like diabetes, heart failure, or chronic kidney disease.

You must have a qualifying diagnosis to enroll. The plan coordinates care specifically for your condition.

Dual Eligible SNPs (D-SNPs)

For people who have both Medicare and Medicaid. These plans coordinate benefits between both programs.

Often include extra benefits like transportation, meal delivery, and help with daily activities.

Institutional SNPs (I-SNPs)

For people who live in nursing homes or require institutional-level care at home.

Provide specialized care coordination for high-needs individuals.

Who Can Enroll in a Special Needs Plan?

You must meet specific eligibility requirements for each type of SNP. Simply wanting to enroll isn't enough.

Basic Medicare Requirements

• Have Medicare Part A and Part B
• Live in the plan's service area
• Not have End-Stage Renal Disease (with some exceptions)

Additional SNP Requirements

For C-SNPs, you need a diagnosis of the plan's specific condition. Common qualifying conditions include:

• Diabetes
• Chronic heart failure
• Chronic kidney disease
• COPD
• Cardiovascular disease
• Mental health conditions

When You Can Enroll

Initial Enrollment Period

You can enroll in a SNP during your Initial Coverage Election Period when you first get Medicare.

Annual Open Enrollment

October 15 to December 7 each year. You can switch to a SNP if you qualify.

Special Enrollment Periods

SNPs have additional enrollment opportunities throughout the year:

• When you first qualify for the SNP (new diagnosis or Medicaid eligibility)
• If you move and lose access to your current plan
• If your current plan stops serving your area
• Certain life events like losing other coverage

The Enrollment Process

Step 1: Verify Your Eligibility

Before enrolling, make sure you meet all requirements. The plan will verify your eligibility after you apply.

For C-SNPs, you'll need medical documentation of your qualifying condition.

Step 2: Compare Available Plans

Look at different SNPs in your area. Compare benefits, costs, and provider networks.

Pay attention to which doctors and hospitals are included in each plan's network.

Step 3: Submit Your Application

You can apply online, by phone, or through a licensed insurance agent.

Have your Medicare card and any required medical documentation ready.

Step 4: Eligibility Verification

The plan will verify you meet all requirements. This might involve contacting your doctors or reviewing medical records.

If you don't qualify, you'll be notified and can choose a different plan.

Required Documentation

Depending on the SNP type, you may need to provide:

• Medical records showing qualifying diagnosis
• Medicaid card (for D-SNPs)
• Proof of nursing home residence (for I-SNPs)
• List of current medications
• Preferred doctors and hospitals

What Happens After Enrollment?

Coverage Start Date

Coverage typically starts the month after you enroll. If you enroll by the 15th, coverage may start that same month.

Plan Materials

You'll receive your member ID card, plan documents, and provider directory within a few weeks.

Care Coordination

Most SNPs assign you a care coordinator who helps manage your health needs and benefits.

Annual Eligibility Reviews

SNPs must verify you still qualify each year. This usually happens automatically through data matching.

If your condition improves or circumstances change, you might no longer qualify for the SNP.

What If You No Longer Qualify?

The plan will help you transition to appropriate coverage. You'll have a Special Enrollment Period to choose a new plan.

Benefits of SNP Enrollment

Coordinated Care

SNPs provide care teams specifically trained in your condition or situation.

Tailored Benefits

Plans often include benefits regular Medicare doesn't cover, like:

• Transportation to medical appointments
• Meal delivery programs
• Home modifications for safety
• Personal care services
• Medication management

Lower Costs

Many SNPs have $0 premiums and lower out-of-pocket costs than regular Medicare Advantage plans.

Potential Drawbacks

Limited Provider Networks

SNPs often have smaller networks than regular Medicare Advantage plans.

Geographic Restrictions

Coverage is limited to the plan's service area. Moving might require changing plans.

Qualification Requirements

You must continue to meet eligibility requirements to keep your coverage.

Remember: SNPs are designed for people with specific needs. If you qualify, they often provide better coordinated care than traditional Medicare options.

Getting Help With Enrollment

SNP enrollment can be complex. Don't hesitate to get help from:

• SHIP (State Health Insurance Assistance Program) counselors
• Licensed insurance agents familiar with SNPs
• Medicare customer service (1-800-MEDICARE)
• Your current healthcare providers

Before You Enroll

Make sure you understand what you're gaining and giving up by switching to a SNP.

Check that your doctors participate in the plan's network. Verify your medications are covered.

Consider whether the plan's extra benefits and care coordination are worth any limitations in provider choice.