Special Needs Plan (SNiP)
September 16, 2009 in Financial Services, Medicaid, Medicare
A Special Needs Plan (SNiP) is category of the Medicare Advantage plan designed to attract and enroll Medicare beneficiaries who fall into a certain special needs demographic. The main objective SNP plan is to accommodate Medicare enrollees who would benefit from a plan covering disease-specific specialists. These types of plans generally cover more benefits and ask you to pay lower co-payments than in the Original Medicare Plan.
There are two types of SNPs.
- The exclusive SNP enrolls only those beneficiaries who fall into the special needs demographic.
- The other type is the disproportionate share SNP. “Disproportionate share” SNPs enroll a greater percentage of the target special needs population as compared to a national percentage of the target population.
More specifically, special needs individuals include:
- Institutionalized Beneficiaries – defined as those who reside or are expected to reside for 90 days or longer in a long term care facility (defined as either: skilled nursing facility (SNF)/NF, ICF or inpatient psychiatric facility), or those living in the community but requiring an equivalent level of care to those residing in a long term care facility.
- Dually Eligible Beneficiaries - defined as individuals who are entitled to Medicare Part A and/or Part B and are eligible for some form of Medicaid benefit.
- Beneficiaries with Chronic Conditions – defined as individuals who have acquired one or more disabling chronic conditions, including, but not limited to: cardiovascular disease, diabetes, congestive heart failure, osteoarthritis, mental disorders, ESRD, and HIV/AIDS.
