Special Needs Plans: D-SNP, C-SNP and I-SNP explained

A Special Needs Plan (SNP) is a Medicare Advantage plan that only enrolls people with certain needs and shapes its doctors, drug list and benefits around them. Every SNP includes Part D drug coverage and care coordination. You need Part A and Part B and must live in the plan's service area.

The three types

D-SNP: Medicare and Medicaid

For people who have both Medicare and help from their state's Medicaid program. Depending on the plan, that can include full Medicaid or a Medicare Savings Program. If you have both, most of your costs are usually covered. Some D-SNPs, called integrated D-SNPs, bring your Medicare and Medicaid benefits together in one plan.

C-SNP: chronic conditions

For people with certain severe or disabling chronic conditions. Medicare allows 15 condition groups: diabetes, chronic heart failure, certain cardiovascular disorders, certain chronic lung disorders, dementia, cancer, stroke, end-stage kidney disease needing dialysis, end-stage liver disease, HIV/AIDS, chronic alcohol and other drug dependence, and certain autoimmune, blood, neurologic and mental health conditions. A plan may serve one condition or a group of related ones, and it must confirm that you have the condition.

I-SNP: nursing-home-level care

For people who have needed, or are expected to need, the care a nursing home or similar facility provides for 90 days or longer. Some I-SNPs also enroll people who live at home but need that level of care, based on a state assessment.

When you can join

• When you first get Medicare, and during Open Enrollment (October 15 to December 7), like any Medicare Advantage plan.
• If you have Medicaid or Extra Help: you can make some changes once a calendar month, including joining or switching to an integrated D-SNP. The change starts on the first day of the next month.
• If you have a qualifying chronic condition: you can join a C-SNP for your condition at any time. Once you join, this chance ends.
• If you live in a nursing home or similar facility: you can join, switch or drop a plan while you live there and for 2 full months after you move out.

If you stop qualifying

If you no longer meet the plan's rules, for example because you lose Medicaid, the plan can end your membership. You can then switch plans starting the month you lose your special needs status, until you join another plan or 3 calendar months after the SNP ends your membership, whichever comes first.

Before you join, check

• That your doctors, specialists and hospitals are in the plan's network. Some SNPs ask you to choose a primary care doctor.
• That your prescriptions are on the plan's drug list.
• The costs. Some SNPs charge a premium on top of the Part B premium, but they can't charge more than Original Medicare for certain services, like chemotherapy, dialysis and skilled nursing care.
• For D-SNPs, which Medicaid benefits the plan includes and which still come through your state.

You can compare SNPs where you live on Medicare.gov's Plan Finder, or get free help from your state's SHIP counselors. Plan star ratings apply to SNPs too.