To qualify for a Medicare 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. To enroll in a SNP, call Medicare (1-800-633-4227) or the plan directly.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.
  • 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 a Special Enrollment Period (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
      • an intermediate care facility for the mentally retarded (ICF/MR)
    • 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.

Dual Eligible SNP (D-SNP) eligibility requirements:

  • You 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 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 find a D-SNP that serves people with an MSP, in addition to people with Medicaid. Plans cannot exclusively serve people with MSPs.

If you meet the SNP’s eligibility requirements, you can join the plan during regular Medicare Advantage enrollment periods.

You may be eligible for a Special Enrollment Period (SEP) to join a SNP if you:

  • Have Medicare and Medicaid. The SEP lasts as long as you have Medicare and Medicaid.
  • Have a severe, disabling, or chronic condition. You can enroll in a SNP that specifically serves people with that condition at any time as long as you have the condition.
  • Are entering an institution that qualifies you for SNP coverage, or develop the need for a nursing home-level of care.
    • Note: You can enroll in or disenroll from an I-SNP at any time.