Special Needs Plan

From Wikipedia, the free encyclopedia

A Special Needs Plan (or SNP, often pronounced “snip”) is new category of Medicare Advantage plan designed to attract and enroll a disproportionate share of special needs individuals. “Disproportionate share” upholds that these plans enroll a greater percentage of a target special needs population as compared to a national percentage of the target population. Under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Congress identified “special needs individuals” as (1) institutionalized, or (2) dually eligible, or (3) individuals with severe or disabling chronic conditions. More specifically, special needs individuals include:

Institutionalized Beneficiaries, defined as those who reside or are expected to reside for 90 days or longer in a long term care facility (defined as either: skilled nursing facility (SNF)/NF, ICF or inpatient psychiatric facility), or those living in the community but requiring an equivalent level of care to those residing in a long term care facility.

Dually Eligible Beneficiaries, definied as individuals who are entitled to Medicare Part A and/or Part B and are eligible for some form of Medicaid benefit.

Beneficiaries with Chronic Conditions, defined as individuals who have acquired one or more disabling chronic conditions, including, but not limited to: cardiovascular disease, diabetes, congestive heart failure, osteoarthritis, mental disorders, ESRD, and HIV/AIDS.