Medicare Special Needs Plans (SNPs): D-SNP, C-SNP, and I-SNP Explained

Here's the short answer. A Medicare Special Needs Plan (SNP) is a type of Medicare Advantage plan that only certain people can join. It gives you the same Part A and Part B benefits as any Medicare Advantage plan, plus care coordination and benefits, doctors, and drug lists shaped for the group it serves. There are three types. A D-SNP is for people who have both Medicare and Medicaid. A C-SNP is for people with a severe or disabling chronic condition, like diabetes, heart failure, or dementia. An I-SNP is for people who live in a facility such as a nursing home, or who need that level of care at home. Every SNP includes Medicare drug coverage (Part D). You can stay in an SNP only as long as you still meet its special rules.

Who can join a Special Needs Plan

You can join an SNP if all three of these are true:

• You have Medicare Part A and Part B.
• You live in the plan's service area.
• You meet the rules for one of the three SNP types, or for a smaller group within one of them.

SNPs are not offered everywhere. Insurance companies decide where they'll do business, so the types available change by state and county from year to year. Congress created SNPs in 2003, and the first plans were offered in 2006.

The three types of SNPs

Sources: Medicare.gov SNP page and CMS SNP pages.

D-SNP: for people with Medicare and Medicaid

A D-SNP enrolls people who are entitled to Medicare and also get Medicaid from their state. Your state covers some of your Medicare costs, depending on the state and your eligibility. The Medicaid groups that can count include full Medicaid, and the Medicare Savings Programs: QMB, SLMB, QI, and QDWI, with or without other Medicaid. States decide their own categories, so what qualifies you can differ by state. Each D-SNP must say whether it charges you $0 for Medicare cost-sharing or not. Our Dual Eligible page explains those categories and the QMB billing protection.

Some D-SNPs are integrated D-SNPs. An integrated plan combines your Medicare benefits and most or all of your Medicaid benefits in one plan. Every integrated D-SNP must:

• Give you one member ID card that works for both Medicare and Medicaid.
• Offer a single health risk assessment that covers both programs.
• Give you a care coordinator or case manager who helps build a personal care plan for your medical and social needs.
• Use one process for appeals and complaints about either your Medicare or your Medicaid coverage.

Not all D-SNPs are integrated. Ask the plan how it works, or call 1-800-MEDICARE for a list of integrated D-SNPs in your area. Many D-SNPs advertise extras like dental, vision, or a prepaid card. Our flex card guide explains what those cards really do.

C-SNP: for people with a serious chronic condition

A C-SNP limits membership to people with specific severe or disabling chronic conditions. Medicare.gov lists these groups: cancer; certain autoimmune disorders; certain cardiovascular disorders; certain chronic and disabling mental health conditions; certain chronic gastrointestinal diseases; certain chronic lung disorders; certain neurological disorders; certain severe blood disorders; chronic alcohol use disorder and other substance use disorders; chronic heart failure; chronic kidney disease and End-Stage Renal Disease; dementia; diabetes; HIV/AIDS; and stroke.

A plan can focus on one condition, on a CMS-approved group of conditions that often go together (like diabetes and heart failure), or on its own custom combination. For a CMS-approved group, you need only one of the conditions to join. For a plan's custom combination, you must have all of them. If you have kidney failure, see our ESRD Medicare guide too.

I-SNP: for people in long-term care

An I-SNP is for people who, for 90 days or longer, have needed or are expected to need the level of care given in a long-term care facility. That includes skilled nursing facilities, nursing facilities, intermediate care facilities for people with intellectual disabilities, and inpatient psychiatric facilities. You can also qualify while living at home if an independent assessor, using your state's assessment tool, finds that you need that level of care. If you live in a facility, check that the plan has providers who serve people where you live. Our long-term care page covers what Medicare does and doesn't pay for in a nursing home.

What you get in an SNP, and what it costs

SNPs are HMO or PPO plans. They cover everything Original Medicare Part A and Part B cover, and they may add extra services for the group they serve. For example, if you have a severe condition like cancer or congestive heart failure and need a hospital stay, an SNP may cover extra days. Here is what Medicare.gov says to expect:

• Monthly premium: varies by plan. Some charge a premium on top of your Part B premium. If you have Medicare and Medicaid, most costs are usually covered for you.
• Drug coverage: yes. Every SNP must include Medicare Part D.
• Doctors and hospitals: varies. Some SNPs require network providers, except for emergency care, urgent care outside the area, or dialysis outside the area. Others cover out-of-network care, but you usually pay more.
• Primary care doctor and referrals: varies. If you have a doctor you like, ask the plan whether you can keep them.
• Care coordination: all SNPs provide it, and they shape their benefits, provider choices, and drug lists for their members.

Two protections apply to all Medicare Advantage plans, including SNPs. Your plan can't charge more than Original Medicare for certain services like chemotherapy, dialysis, and skilled nursing facility care. And if your plan approves a treatment, that approval must last as long as the treatment is medically necessary. If you switch plans during treatment, the new plan must wait at least 90 days before asking for a new approval. See prior authorization in Medicare Advantage for how approvals work.

When you can join, switch, or leave an SNP

The regular Medicare Advantage windows apply. You can join, switch, or drop a plan during Open Enrollment, October 15 to December 7, with coverage starting January 1. If you're already in a Medicare Advantage plan, you can make one change between January 1 and March 31. SNPs also come with their own Special Enrollment Periods:

• You have Medicaid or Extra Help: you can change your drug coverage, or drop a Medicare Advantage plan with drug coverage for Original Medicare plus a drug plan, once each calendar month. The change starts the first day of the next month.
• You have full Medicaid benefits: you can join or switch to an integrated D-SNP once each calendar month, if one is available in your area.
• You have a qualifying chronic condition: you can join a C-SNP that serves your condition at any time. Once you join, that Special Enrollment Period is used up.
• You no longer meet the plan's special rules: you can switch to a drug plan or another Medicare Advantage plan. Your window starts the month you lose your special-needs status and ends when you join another plan, or 3 months after the plan disenrolls you, whichever comes first.
• You lose Medicaid: you have 3 full months from the date you lose eligibility, or the date you're told, whichever is later, to change plans.

Some of these windows aren't available if your Part D plan has flagged you as "at-risk" under a drug management program. Our Enrollment & Deadlines page lists every Medicare window.

Questions to ask before you join an SNP

1. Am I really eligible? Ask the plan to confirm your Medicaid category, your diagnosis, or your facility status. If you stop meeting the rules later, you'll have to leave the plan.
2. Is it integrated? For a D-SNP, ask whether it combines your Medicaid benefits too, or only coordinates them.
3. Are my doctors in the network? Check your primary care doctor, specialists, dialysis center, and pharmacy.
4. Are my drugs on the list? Enter your prescriptions in Medicare Plan Finder to compare drug costs plan by plan.
5. What will I pay? Ask about the premium, copays, and the plan's yearly out-of-pocket limit. If you have Medicaid, ask what the state covers.

Free, unbiased help is available from your State Health Insurance Assistance Program (SHIP). Be careful with unsolicited calls or door-knocks about "special" plans. See Medicare scams for the warning signs.

Common questions

Official sources

• Medicare.gov: Special Needs Plans (SNP)
• CMS.gov: Special Needs Plans overview
• CMS.gov: Dual Eligible SNPs (D-SNPs)
• CMS.gov: Chronic Condition SNPs (C-SNPs)
• CMS.gov: Institutional SNPs (I-SNPs)
• Medicare.gov: Special Enrollment Periods