Medicare Advantage - Special Needs Plans

Managed care enrollees who are enrolled in a Medicare Advantage plan may choose a Special Needs Plan (SNP), also called “snips.” An SNP is a special type of managed care product that provides more focused health care for specific groups of people, such as those who have both Medicare and MA, who reside in a nursing home, or who have certain chronic medical conditions.

SNPs are approved by the Centers for Medicare and Medicaid Services (CMS).

Definition: Administers the Medicare program and works in partnership with the States to administer Medicaid and other programs. Formerly known as HCFA.

They are considered part of the low income subsidy for Medicare Part D

Definition: A prescription drug coverage plan that has been designated by Medicare to meet certain coverage requirements and which has a monthly premium that is fully subsidized by Extra Help.
and pay the benchmark premium for the client.

There are several advantages

Better coordination between Medicare and MA services.
For example, all covered Medicare and MA prescription drugs are covered under an SNP, including medications covered under Medicare Part D. Instead of three different payment sources, there is only one.
Simplified access to both Medicare and MA services through alignment of clinical, care coordination and delivery incentives.
Requirements to provide additional assessment and care planning to strengthen care for people with complex conditions.
Alignment of Medicare and MA networks and services across the full continuum of care (primary, acute and long-term care).

of being enrolled in an SNP.

Integration of coverage decisions with the coordination of Medicare and MA helps avoid confusion for members.