Medicare Interactive

How do I qualify for a SNP?

Section V.f. Medicare Special Needs Plans (SNPs)

Question 6 of 8 (use "Last" or "Next" buttons to see more)

Last Update: April 29, 2009

To qualify for a SNP, you must fill out an application and prove that you meet the SNP’s eligibility criteria. (The SNP will require periodic proof that you continue to meet these criteria.)

To be eligible for an institutional SNP, you must either:

Have lived, for at least 90 days, in a long-term care facility that is served by the SNP, such as:
- a nursing home (facility that provides skilled care);
- an intermediate care facility for the mentally retarded (ICF/MR); or
Have met your state's guidelines for requiring an institutional level of care for at least 90 days, whether you live in an institution or in a community setting (for example, at home or in a group residence).

Note: You can still qualify for an institutional SNP before you have received care for at least 90 days if it is likely that you will need long-term care for at least 90 days.

To be eligible for a SNP that serves people with both Medicare and Medicaid the plan must verify that you have Medicaid. You can show your Medicaid card or a letter from Medicaid, or you can fill out the plan’s enrollment form and the plan can verify your Medicaid enrollment status with Medicaid.
Note: Some SNPs may only serve people with full Medicare and Medicaid benefits. If you get help paying for Medicare with a Medicare Savings Program you will not qualify for a SNP that only serves “full” dual-eligibles. You may qualify for one that serves both people with full Medicaid benefits and those with Medicare Savings Programs. SNPs can not exclusively enroll people with Medicare Savings Programs.
To be eligible for a SNP that serves people with a specific chronic condition you must get a note from your doctor confirming that you have the condition. The chronic care SNP may enroll you in the SNP before it gets the confirmation from your doctor, but if it cannot verify that you meet the eligibility criteria by the end of the first month that you are enrolled, you will be disenrolled from the SNP at the end of the next month. You will have a Special Enrollment Period to enroll in a new plan, which will begin when you are first notified by your plan that you are being disenrolled, and will continue for the two following months. During this time, you can enroll in Original Medicare or another Medicare private health plan. If you choose a private health plan, make sure that it covers the doctors and hospitals you use and the services you need.

For a list of questions you should ask if you are considering joining a SNP, click on the link in the GO TO box.

To find out about your Medicare coverage options, click on the link in the GO TO box.