For you to understand the definition and basic scope of the different types of SNPs
Special needs plans (of SNPs) are a type of Medicare Advantage Coordinated Care Plan (CCP) that can be customized for members with more intense healthcare needs. There are three major types of SNPs: D-SNPs for Medicare-Medicaid dual eligible members, C-SNPs for members with certain chronic conditions, and I-SNPs for members residing in institutions for 90 days of more.
The Big Topics in This Lesson
1- Definition of Special Needs Plans
The information under this topic covers basic information how Medicare Advantage Special Needs Plans are defined and designed.
2- Different Types of SNPs
The information under this topic reviews the main types of SNPs available.
Lesson Q & A
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A Medicare Advantage Special Needs Plan (MA-SNP) is type of Medicare managed care plan with specific enrollment criteria and benefit packages. SNPs target services based on member characteristics (such as certain conditions or acuity), and are designed to improve healthcare delivery for sicker Medicare members.
There are 3 types of MA-SNPs:
- D-SNPs, which serve Medicare members who are eligible for both Medicare and Medicaid services. These SNPs are tailored to members with low income, and require coordination with the state Medicaid agency.
- C-SNPs, which serve Medicare members with specific chronic conditions. Services and network are designed to improve treatment of these conditions. CMS approves 15 specific conditions for use in C-SNP design.
- I-SNPs, which serve Medicare members living in institutions for at least 90 days.
CMS uses 4 main categories to classify D-SNPs:
- All dual DSNPs- These plans must enroll all dual eligible members, including those with full Medicaid benefits and those with limited cost sharing.
- Full benefit DSNPs- These plans enroll dual eligibles who are eligible for full Medicaid benefits.
- Medicare Zero Cost Sharing DSNPs- these plans enroll only QMBs and QMB+ members (these are the two eligibility categories that have low enough incomes to have no cost sharing on Medicare Part A or B).
- Dual eligible subset DSNPs- these plans can (with approval and coordination with the state Medicaid agency) limit enrollment to certain groups of duals.
New Terms from this lesson:
- SNP- Special Needs Plan
- C-SNP- Chronic conditions special needs plan
- D-SNP- Dual eligible special needs plan
- I-SNP- Institutional special needs plan
- HIDE-SNIP- Highly integrated dual eligible special needs plan
- FIDE-SNIP- Fully integrated dual eligible special needs plan
- CCP- Coordinated care plan
- Dual eligibles- Members eligible for both Medicare and Medicaid coverage
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