Plan guide
Special Needs Plans
Plans designed around a specific situation, with care coordinators, extra benefits and drug coverage built in.
Overview
Special Needs Plans, or SNPs, are a type of Medicare Advantage plan limited to people who meet certain criteria. Every SNP must include Part D prescription coverage and a care coordination model built for its members.
There are three kinds. Dual Eligible SNPs (D-SNPs) serve people with both Medicare and Indiana Medicaid, including many members of Indiana PathWays for Aging. Chronic Condition SNPs (C-SNPs) serve people with conditions such as diabetes, chronic heart failure or COPD. Institutional SNPs (I-SNPs) serve people who live in a nursing home or need that level of care at home.
Because eligibility rules are specific and benefits vary widely, SNPs are one area where a conversation with a licensed advisor matters. We verify Medicaid levels, coordinate with your care team, and make sure the plan works with your current providers.
What's included
All Medicare Part A and B services
Hospital and medical coverage with low or no copays for many dual-eligible members.
Built-in Part D coverage
Every SNP includes prescription drug coverage.
Care coordinator
A named contact who helps schedule visits, manage medications and arrange transitions.
Condition-specific programs
Diabetes supplies, cardiac monitoring or respiratory support depending on plan type.
Supplemental benefits
Grocery and OTC allowances, transportation to appointments and meal delivery on many D-SNPs.
Special enrollment flexibility
Dual-eligible members can change plans once per month in certain situations.
D-SNP, C-SNP and I-SNP: who qualifies for which
All three are Medicare Advantage plans built for a defined population. What separates them is the proof of eligibility each one requires, and what happens when that proof lapses.
- D-SNP
Dual Eligible Special Needs Plan
You hold Medicare and Indiana Medicaid at the same time, either full benefits or a Medicare Savings Program.
How it is proved. The plan checks your Medicaid status with the state every month. Lose Medicaid and you get a grace period, usually six months, before the plan has to disenroll you.
- Care coordination that speaks to both programs instead of one
- Highly integrated (HIDE) and fully integrated (FIDE) versions merge the two cards
- Full-benefit duals in an integrated plan may switch monthly; other duals get one switch in each of the first three quarters
- C-SNP
Chronic Condition Special Needs Plan
You live with one of the 15 severe or disabling chronic conditions CMS approves, such as diabetes, chronic heart failure, COPD, end-stage renal disease or dementia.
How it is proved. A physician has to verify the condition. A plan may enroll you first and confirm afterwards, but coverage ends if that verification never arrives.
- Formularies and specialist networks built around the condition
- Condition-specific supplies, care teams and lower copays on the drugs that treat it
- A Special Enrollment Period opens when a qualifying diagnosis is confirmed
- I-SNP
Institutional Special Needs Plan
You have lived, or are expected to live, 90 days or longer in a nursing facility, assisted living or a similar setting.
How it is proved. A state-approved assessment confirms you need an institutional level of care, and it is repeated on the plan's schedule.
- Nurse practitioners who round in the building instead of in a clinic
- The institutional-equivalent version covers that level of care at home
- Care plans written with facility staff, family and the attending physician
- Drug coverage is never optionalEvery Special Needs Plan includes Part D. You cannot pair one with a stand-alone drug plan, and joining one would drop you out of the SNP.
- A model of care CMS approvesEach SNP files a Model of Care scored by NCQA: who the plan is for, who sits on the care team, and how transitions between settings are handled.
- A health risk assessmentWithin 90 days of enrollment, and again every year, the plan must complete an assessment and build an individual care plan from it.
- You can stop qualifyingLosing Medicaid, leaving a facility, or a condition that cannot be verified all end eligibility. The plan must notify you and give you a window to move.
Costs to plan for
Sample figures- Monthly premium
- Often $0
- Primary care copay
- $0
- Drug copays
- $0 to $12.65
- OTC allowance
- $50 to $300/qtr
Many D-SNPs, depending on Medicaid level (sample)
Common on D-SNPs (sample)
With full Extra Help (sample)
Varies by plan (sample)
Figures are illustrations for Central Indiana. Your actual costs depend on the plan, your ZIP code, age and income. Confirm current amounts at Medicare.gov.
How we help with Special Needs Plans
- 1
Confirm eligibility
We verify Medicaid category, qualifying chronic condition or level of care.
- 2
Check providers
We make sure your doctors, specialists and home health agency are in network.
- 3
Coordinate with Medicaid
We explain how Medicare and Indiana Medicaid benefits work together.
- 4
Enroll and connect
We help schedule the plan's health assessment and introduce your care coordinator.
Is it a fit?
Often a good fit when
- You have both Medicare and Indiana Medicaid
- You live with diabetes, heart failure or COPD
- You want help coordinating many providers
Watch out for
- Strict eligibility rules and annual verification
- Networks are usually HMO-style
- Losing Medicaid eligibility triggers a grace period
Questions about Special Needs Plans
If you receive full Indiana Medicaid or a Medicare Savings Program such as QMB, SLMB or QI, you may qualify for a D-SNP. We can confirm your level with a quick review of your Medicaid letter.
Only if your doctor is in the plan network. We check every provider before enrollment and flag any that are not covered.
D-SNPs typically give a grace period, often several months, to regain eligibility. If you do not, you will have a special enrollment period to choose another plan.
Related coverage
Medicare AdvantagePart C plans from private carriers that bundle hospital, medical and usually drug coverage.Read the guide 
Part D drug plansStand-alone prescription drug coverage to pair with Original Medicare and a Supplement.Read the guide 
Dental, vision and hearingCoverage for the routine care Original Medicare generally does not pay for.Read the guide
Questions about Special Needs Plans?
A licensed Beacon advisor will compare plans against your doctors, prescriptions and budget. No cost, no obligation.
Licensed in Indiana. TTY 711. Mon - Fri 8:00 am - 6:00 pm