Could you qualify for a Medicare Advantage 澳洲幸运5官方开奖结果体彩网:Special Needs Plan (SNP)? Since 2010, SNP enrollees have more than doubled, going from 12% of total Medicare Advantage enrollment to an estimated 28% in 2025, according to 澳洲幸运5官方开奖结果体彩网:Centers for Medicar🐓e and Medicaid Services and policy organization KFF. To be eligible, you’ll need to meet certain income or health needs requireme♕nts. 

Understanding SNPs

Like other kinds of 澳洲幸运5官方开奖结果体彩网:Medicare Advantage plans, SNPs cover Part A (hospital care), Part B (physician visits and some device charges), and, typically, Part D (prescription drugs). 

The three major kinds of SNPs are:

• Dual-Eligible Special Needs Plans (D-SNPs): for people eligible for both 澳洲幸运5官方开奖结果体彩网:Medicare and Medicaid. Most SNP enrollees (88%) are in these plans. 
• Chronic Condition Special Needs Plans (C-SNPs): for people with severe or disabling chronic conditions such as cancer, chronic heart failure, stroke, or diabetes. These plans specialize in one particular condition, so you may see a cancer SNP or a heart disease SNP.
• Institutional Special Needs Plans (I-SNPs): for people who live in a medical institution for at least 90 days. These include long-term care facilities, nursing homes, and inpatient psychiatric facilities. You can also get coverage if you live in the community and need institution-level care.    

Enrollment in SNPs is up partly because more plans are available. The number of SNPs offered grew 9% between 2024 and 2025 and now represents about a quarter of total plans.

More enrollees are also accessing plans—even those under 65. Medicare beneficiaries under 65 澳洲幸运5官方开奖结果体彩网:may be eligible for D-SNPs; nearly 40% of SNP enrollees are under 65. 

Do You Qualify for an SNP?

An SNP requires you to m♑eet health or♑ income criteria. 

The most basic qualifications for a 澳洲幸运5官方开奖结果体彩网:Medicare Advantage plan is enrollment in Original Medicare Parts A and B, plus living in the Medicare Advantage plan’s service area.  This can be a cha♏llenge because not all SNPs serve all counties. In rural areas, there may be fewer plans and physicians serving fewer people, said Danielle Kunkle Roberts, co-founder of Boomer Ben🐼efits, a Fort Worth, Texas-based Medicare insurance agency, and author of “10 Costly Medicare Mistakes You Can't Afford to Make.” 

Although the vast majority (88%) of people in SNPs are in dual-eligible plans (D-SNPs), many people don’t know they’re eligible for one or even know they exist. Why not? “Because they've never applied for Medicaid," said Roberts.

Not knowing one’s eligibility is particularly true for those close to the 澳洲幸运5官方开奖结果体彩网:federal poverty line, she said. Medicaid qualification can be confusing, as income limiꦉts vary by state. 

Because state Medicaid programs may pick up many of the out-of-pocket costs for people in D-SNPs, enrollment can be particularly beneficial for Original Medicare enrollees without Medigap plans, Rober❀ts said—which means they’re on the hook for paying 20% o🃏f most healthcare costs. 

With a C-SNP, the insurance c♋ompany will contact your doctor to confirm your diagnosis. In most urban areas, the more common C-S🐠NPs are for diabetes and cardiovascular conditions. Fewer options exist for less widespread chronic conditions, such as dementia or HIV. 

The benefit of a C-SNP is that you get much more coordinated care than you would with a regular Medicare Advantage plan. “There are thousands of people out there who are not good at coordination and managing information and care instructions being provided by multiple doctors,” said Roberts. “We see this especially as they get older and if they don’t have adult children helping them.”

Ho꧂w to Choose a Medicare ♎Advantage Special Needs Plan

Once you know you’re eligible, the next step is choosing a plan. You’ll usually need to do this during Medicare open enrollment, which is going on now until December 7. If you’re already in a Medicare Advantage plan, you can also switch your plan during 澳洲幸运5官🐼方开奖结果体彩网:Medicare Advantage open enrollment period Jan. 1 through March 31, 2025. 

🥀 If you develop a qualifying chronic conditioꩲn, you may be eligible to enroll in a C-SNP outside of the open enrollment periods. Roberts said she sometimes chooses a C-SNP if someone can no longer afford their Medigap plan and needs to exit it mid-year. 

“Instead of waiting until the next open enrollment period to get an MA plan, we can do a mid-year enrollment in𓂃to a C-SNP based on them hav🅺ing a health condition,” she said. “Then we can re-evaluate in the next open enrollment period as to whether that plan is still right for them or if there is another MA plan that has more attractive benefits.” 

Where to Find Plan Details 

While the can help y💛ou find SNPs available in your area, it’s unlike Tripadvisor, where every detail is searchable or mentioned. You’ll have to go to the carrier site to double-check most of the plan’s details. 

Look for 2025 benefits and c🐟osts in the plan’s summary of benefits, see what drugs are on the formulary (covered drugs list), and view providers within the network directory.  

You can find this by visiting the provider's website, entering your ZIP code, and downloading plan details. Unfortunately, the benefits and formulary are typically found in lengthy PDF documents rather than easily searchable or readable online formats. In-network providers may be in a searchable directory. 

Coverage Details to Check 

Once you’ve🥃 found the right materials, here are the things to look foꦕr:

Provider Networks

Compare if and how the plan covers your current doctors and spec𝓡ialists. Some plans may have provider networks with more experience with your condition. Ensure your current doctors, specialists, or preferred healthcare facilities are in-network. 

Formularies and In-Network Pharmacies

Make sure your medications are covered. "Sometimes people assume that if a plan is for diabetes, it covers all insulin, but your specific brand of insulin may not be within the plan's formulary," Roberts said. 

If so, you may have to switch medications, which your pღhys🤡ician may not want you to do.

Care Coordination

Dig into the details to learn how the SNP provides special services such as case management. With a C-SNP, you'll be assigned a care coordinator who can develop a care plan for you and coordinate among primary care providers, specialists, inpatient and outpatient facilities, and ancillary services. The plan should tailor its provider choices and drug coverage to the needs of people with your particular condition.

Roberts provided this example: C-SNP coverage for diabetes may include access to blood glucose monitors, insulin management training, and nutritional counseling. “Your primary care physician might work with your endocrinologist to come up with a plan for care that best addresses your needs and a plan to achieve certain health outc🦋omes.” 

For D-SNPs, check the integration level. Roberts suggested you speak with an agent about enrolling in a fully integrated or highly integrated D-SNP, if available. These plans may have improved integration of Medicare and Medicaid benefits. Less-integrated plans may require you to be more involved because they have more limited🏅 care coordination and separate entities for Medicare and Medicaid.

For 2025, CMS has made it easier for eligible people to switch to fully integrated plans. These plans are easier for both customers and administrators and can have unified plan documents, as well as unified grievance and appeals systems.  

Medicare Star Ratings

Based on customer feedback and other metrics, Medicare plans get one to five stars. Higher 澳洲幸运5官方开奖结果体彩网:Medicare star ratings usually indicate better cu♐stomer service and quality of care from health care providers in the plan’s network. 

Investopedia research shows that in 2025, D-SNP and C-SNP plans tend to have lower star ratings than Medicare ♈Advantage plan𒅌s. This means you should carefully examine the star rating of any plans you’re considering. 

Additional Services, Benefits and Support 

Most C-SNPs 🎉and𒉰 D-SNPs can offer special benefits, such as dentures or home health coverage, Roberts said.  

For example, Roberts noted that some offer specific transportatio﷽n services that ensure you arrive on time for appointments. A D-SNP may provide up to 36 rideshares a year for doctor visits. 

But don't get too swayed by all the shiny extras, Roberts warned. "With MA plans, people will maybe miss important benefits because they're so dead-set on chasing a grocery card, but they need the right plan to deal with a cardiac event or cancer," she said.

Costs 

Compare how much you'll pay for premiums, doctor’s visits, and prescriptions. Some D-SNP plan members only pay a dollar or two for prescriptions. 

• Out-of-pocket costs. 澳洲幸运5官方开奖结果体彩网:Copayments, 澳洲幸运5官方开奖结果体彩网:coinsurance, 澳洲幸运5官方开奖结果体彩网:deductibles, and 澳洲幸运5官方开奖结果体彩网:maximum out-of-pocket limits will be displayed on your benefits summary. While the government picks up more of an SNP’s costs than a traditional Medicare Advantage plan, you may still face some expenses that vary between plans. 
• 澳洲幸运5官方开奖结果体彩网:Premiums: As with other Medicare Advantage plans, many SNPs have very low or $0 monthly premiums. 
• Medications: Make sure you can afford copays or coinsurance for your medication tiers. 

Find an Agent for More SNP Help

Healthcare agents and brokers can help you compare options and determine which plans you migh꧋t qualify for.  

Use the "" on♌ the National Association of Benefits and Insurance Professionals site to find an agent who stays current on healthcare education and pays for professional development. "You'll get a better-quality agent, not a fly-by-night perso﷽n who's in it for one season to make a few thousand" said Roberts.

An agent can help you carefully examine a plan’s unpleasant surprises or disadvantages and ♊consider the big picture. 💯