Understanding Special Needs Plans
Laying a Solid Foundation | Lesson 2

Overview of Special Needs Plans

When it comes to Special Needs Plans, there are three different types: D-SNPs, C-SNPs, and I-SNPs.

D-SNP stands for Dual Eligible Special Needs Plan and is the most commonly sold of the three SNPs.

These plans are for those who are eligible for both Medicare and Medicaid.

These products will cater their coverage to beneficiaries with limited out-of-pocket expenses and helpful value-added services to help them stay healthy, like over-the-counter allowances and dental, vision, and hearing benefits.

Up next, we have the C-SNPs or Chronic Condition Special Needs Plans.

C-SNPs are for Medicare-eligible clients who are diagnosed with one or more qualifying conditions.

While not as common as their dual-eligible counterparts, these plans offer value to beneficiaries by adjusting their drug formulary and provider networks to help the beneficiary successfully manage his or her chronic condition.

The third and final plan is the Institutional Special Needs Plan or I-SNP.

I-SNPs are for individuals who are eligible for Medicare and live in an institution, like a nursing home, or require home health care.

In recent years, I-SNPs only account for about two percent of all Special Need Plan enrollments and are not typically agent sold, but we still want to ensure that you know the basics.

Remember that all Special Needs Plans are a type of Medicare Advantage plan, and there are some things that you should keep in mind as we go through this module.

First a note about enrollment. We’ll talk about the special enrollment opportunities for Special Needs Plans but remember that eligible beneficiaries can enroll in these plans during normal enrollment periods as well.

Next, when it comes to costs, these plans have a similar cost structure to other Medicare Advantage products.

They’ll have a monthly premium, although it could be a zero-dollar premium, and out-of-pocket costs when using services.

Lastly, they also hold to the same network requirements, as well. Most Special Needs Plans are HMOs, but some are PPOs as well.

Just like a standard Medicare Advantage plan, SNPs that are HMOs will require the beneficiary to receive care from in-network providers for services to be covered.

If you’d like to review more about Medicare Advantage products, be sure to check out that module, also in Path two!

Now that we’ve covered those basics, head over to the next lesson for a deep dive into D-SNPs.

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