Medicare Advantage plans are available in four main types: Special Needs Plans (SNP), Health Maintenance Organization (HMO), Private Fee-for-Service (PFFS), and Preferred Provider Organization (PPO). Each offers different levels of flexibility, cost, and provider access, depending on your healthcare needs and preferences.


Special Needs Plans (SNPs) are a type of Medicare Advantage plan (Part C) specifically designed to serve individuals with unique healthcare needs. Offered by private insurance companies approved by Medicare, SNPs must provide the same core benefits as Original Medicare Parts A and B, but they also include tailored services and care coordination for people who meet certain eligibility criteria.


Special Needs Plans (SNPs) generally require you to receive care from in-network providers, unless it’s an emergency, or you’re out of state with End-Stage Renal Disease (ESRD) and need dialysis. All SNPs include Medicare Part D prescription drug coverage. Most plans also require you to work with a primary care doctor or care coordinator who helps manage your care. In most cases, referrals are needed to see specialists, unless the service is classified as preventive, such as annual screening mammograms or pap tests performed in-network.

Medicare Special Needs Plans Coverage

Special Needs Plans (SNPs) provide all-in-one Medicare coverage, combining Part A (inpatient care), Part B (outpatient services), and

Part D (prescription drug coverage). Like other Medicare Advantage plans, SNPs offer the same core benefits as Original Medicare —but with additional support tailored to your health needs. These extra services may include things like extended hospital stay allowances, access to a care management specialist, or social services based on your individual condition or situation.

Types of SNP

There are three types of Special Needs Plans (SNPs), each designed to meet specific healthcare needs: the Chronic Condition SNP (C SNP), the Dual Eligible SNP (D-SNP), and the Institutional SNP (I-SNP). Each offers targeted benefits based on your unique health situation and eligibility.

Chronic Condition Special Needs Plan

While many Medicare beneficiaries live with multiple chronic conditions, Chronic Condition Special Needs Plans (C-SNPs) are designed specifically for those with serious, disabling, or life-threatening health issues. These individuals often face complex medical needs, higher hospitalization risks, and require specialized, coordinated care. Conditions that may qualify you for a C-SNP include cancer, dementia, End-Stage Renal Disease (ESRD), HIV/AIDS, and amyotrophic lateral sclerosis (ALS). In total, Medicare recognizes 15 qualifying conditions, some of which include broad categories like cardiovascular disorders and chronic lung diseases.

If you’ve been diagnosed with one of these eligible conditions, you may qualify for a Chronic Condition SNP :

- cancer

- stroke

- chronic heart failure

- HIV/AIDS

- dementia

- End-stage Renal disease

- diabetes type 2

- End-stage Liver disease

- neurological issues

- autoimmune disorders

- mental health conditions

- cardiovascular disease

- lung disease

- hematologic disorders

- substance use disorder

To enroll in the chronic disease program, you will have to provide a note from your doctor stating that you have one of the covered conditions. You will probably be required to submit to a medical underwriting process.

Dual Eligible SNP

Dual Eligible Special Needs Plans (D-SNPs) are designed for individuals who qualify for both Medicare and Medicaid. Eligibility levels can vary — from full dual eligibility to partial assistance under programs like Qualified Medicare Beneficiary (QMB). These plans often include low or zero-dollar cost sharing, helping reduce out-of-pocket expenses for those who need it most.

To enroll in a D-SNP, you’ll need to provide proof of Medicaid enrollment, such as a Medicaid card or official eligibility letter.

Institutional Special Needs Plan

Institutional Special Needs Plans (I-SNPs) are designed for individuals who reside in long-term care facilities or require an institutional level of care. Eligible settings include skilled nursing facilities, nursing homes, inpatient psychiatric facilities, and intermediate care centers for individuals with intellectual disabilities. To qualify, you must have lived in one of these facilities for at least 90 consecutive days or meet your state’s criteria for needing a higher level of care.

Enrollment in an I-SNP also requires verification of your care level by an independent assessment to confirm eligibility.

Special Needs Plans Enrollment


You can enroll in a Special Needs Plan (SNP) during the Medicare Advantage Open Enrollment Period or a Special Enrollment Period. Special Enrollment may apply if you experience changes in your health condition, residence, employment, or current coverage. It’s also available to those who are eligible for both Medicare and Medicaid.

If you have a qualifying chronic condition or require an institutional level of care, you may be able to enroll in an SNP at any time.

To qualify, you must already be enrolled in Original Medicare (Part A and Part B) or a Medicare Advantage (Part C) plan.

Let us simplify Medicare and Health

Insurance for you—at no cost!

Navigating healthcare and Medicare

doesn’t have to be stressful. At Cole Insure,

we specialize in offering tailored solutions

to meet your unique needs, ensuring you feel

supported and covered every step of the way.

Located in Kansas City, Missouri!

We are not connected with or endorsed by the United States government or the federal Medicare program. Health Insurance

sold on www.coleinsure.com is processed through the licensed entity: Cole Insure LLC

Copyright © 2024 Cole Insure. All Rights Reserved.