Enrolling in a SNP

To qualify for a Medicare Special Needs Plan (SNP), you must apply and prove that you meet the SNP’s eligibility criteria. The SNP will require periodic proof that you continue to meet these criteria. If you meet the SNP’s eligibility requirements, you can join the plan during regular  Medicare Advantage Medicare Advantage Medicare Advantage, also known as Part C, Medicare Private Health Plan, or Medicare Managed Care Plan, allows you to get Medicare coverage from a private health plan that contracts with the federal government. All Medicare Advantage Plans must offer at least the same benefits as Original Medicare (Part A and Part B), but can do so with different rules, costs, and coverage restrictions. Plans typically offer Part D drug coverage as part of Medicare Advantage benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medicare Medical Savings Accounts (MSAs).   enrollment enrollment Enrollment is joining Original Medicare or becoming a member of a Medicare Advantage Plan or Part D plan.  periods. To enroll in a SNP, call Medicare (1-800-633-4227) or the plan directly. 

Dual Eligible SNP (D-SNP) eligibility requirements:

• You must verify that you have Medicaid. You can show your Medicaid Medicaid Medicaid is a federal and state program that provides health coverage for certain people with limited income and assets.  card or a letter from Medicaid, or you can fill out the plan’s enrollment form and the plan can verify your enrollment status with Medicaid.
  • Some D-SNPs only serve beneficiaries with Medicare and full Medicaid benefits. If you are enrolled in a Medicare Savings program (MSP), you will not qualify and must choose Original Medicare Original Medicare Original Medicare, also known as Traditional Medicare, is the fee-for-service health insurance program offered through the federal government, which pays providers directly for the services you receive. Almost all doctors and hospitals in the U.S. accept Original Medicare. , a Medicare Advantage Plan that is open to all Medicare beneficiaries, or a D-SNP that serves people with an MSP in addition to people with Medicaid. Plans cannot limit enrollment to people with MSPs and refuse to enroll people with full Medicaid.
• You have a Special Enrollment Period (SEP) Special Enrollment Period (SEP) Special Enrollment Periods (SEPs) are periods of time outside normal enrollment periods when you can enroll in Medicare or change your health and/or drug coverage. One example is the Part B SEP, which allows you to enroll in Part B without penalty while you have job-based insurance and for eight months after you lose the insurance or stop working. SEPs triggered by specific circumstances may also allow you to switch or disenroll from Part D and Medicare Advantage Plans. For example, if you moved out of your plan’s service area, you would receive an SEP to switch to another plan.  to enroll in a D-SNP when you first get Medicaid.
• You have an SEP to enroll in an integrated D-SNP if you have Medicare and Medicaid. An integrated D-SNP meets certain requirements to provide Medicare and Medicaid services together. The SEP can be used once per month.

Chronic Condition SNP (C-SNP) eligibility requirements: 

• You must get a note from your doctor confirming that you have the condition addressed by the SNP.
• You have an SEP to enroll in a C-SNP if you have a severe, disabling, or chronic condition. You can enroll in a C-SNP that specifically serves people with that condition at any time as long as you have the condition.
• The C-SNP may enroll you before getting confirmation from your doctor, but if it cannot verify your eligibility by the end of your first month enrolled, you will be disenrolled from the plan at the end of the next month.
  • You will have an SEP to enroll in a new plan, beginning when you are first notified by your plan that you are being disenrolled, and ending after two months.

Institutional SNP (I-SNP) eligibility requirements:

• You must either:
  • Live for at least 90 days in a long-term care (LTC) facility that is served by the SNP, such as:
    • a  nursing home nursing home A nursing home, also called a long-term care facility, is a residential facility for people with chronic illness or disability. Nursing home services include room and board, nursing care, personal care, and therapy services. A skilled nursing facility (SNF) is a nursing home that provides skilled care, but not all nursing homes are SNFs. Medicare does not cover the cost of nursing homes that are not SNFs.
    • an  Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID) Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID) are nursing facilities specifically designed to provide active treatment to individuals with intellectual disabilities and other related conditions.
  • Or, meet your state’s guidelines for requiring a nursing home-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)
• You can still qualify for an I-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.
• You have an SEP to enroll in an I-SNP if you are entering an institution that qualifies you for SNP coverage, or if you develop the need for a nursing home-level of care. You can enroll in or disenroll from an I-SNP at any time.