Module 2 - Medicare Advantage SNP Plans

Question 1

Are SNP plans a type of plans that fall under Medicare Advantage, exclusively?

Answer 1

Yes, SNP (Special Needs Plans) are a type of Medicare Advantage Plan1. They limit membership and provide customized care to people with specific diseases, characteristics, or financial circumstances1. There are three types of SNP plans1:

C-SNP: For those with chronic conditions like cancer, diabetes, or HIV/AIDS.
D-SNP: For those who are eligible for both Medicare and Medicaid.
I-SNP: For those who are institutionalized.
SNP plans tailor their benefits, provider choices, and drug formularies to best meet the needs of the groups they serve1. So, they are indeed a part of Medicare Advantage, but they are designed to cater to specific needs.

Question 2

There are several types of Special Needs Plans, what are they?

Answer 2

1. Chronic condition SNPs (C-SNPs) are SNPs that restrict enrollment to individuals with certain chronic or disabling chronic conditions, such as diabetes, heart failure, cancer, lung conditions, HIV, or certain other conditions.

Each C-SNP will specify the condition or conditions necessary to be eligible to enroll.

Question 3

What are Dual-eligible SNPs (D-SNPs)?

Answer 3

Dual-eligible SNPs (D-SNPs) enroll beneficiaries who are entitled to both Medicare and Medical assistance from a State plan under Medicaid. There are two types of D-SNPs:

1. Fully integrated dual-eligible (FIDE) SNPs, provide dual-eligible enrollees coordinated access to Medicare and Medicaid benefits (including Medicaid primary care acute care, and long-term services and supports) under a single organization that has a Medicare Advantage and Medicaid managed care contract.
2. Highly integrated dual-eligible (HIDE) SNPs cover Medicaid benefits under a capitated contract between the State Medicaid agency and the MA organization, the MA organization’s parent organization, or an affiliate. HIDE SNPs cover long-term services and support, or behavioral health services.

Question 4

What is a Fully integrated dual-eligible (HIDE) SNP?

Answer 4

Fully integrated dual-eligible (FIDE) SNPs, provide dual-eligible enrollees coordinated access to Medicare and Medicaid benefits (including Medicaid primary care acute care, and long-term services and supports) under a single organization that has a Medicare Advantage and Medicaid managed care contract.

Question 5

What is a Highly integrated dual-eligible (HIDE) SNP?

Answer 5

Highly integrated dual-eligible (HIDE) SNPs cover Medicaid benefits under a capitated contract between the State Medicaid agency and the MA organization, the MA organization’s parent organization, or an affiliate. HIDE SNPs cover long-term services and support, or behavioral health services.

Question 6

What are the institutiional SNPs Plans?

Answer 6

Institutional SNPs (I-SNPs) are SNPs that restrict enrollment to MA-eligible individuals who, for 90 days or longer, have had or are expected to need the level of services provided in a skilled nursing facility, a nursing facility (NF) as defined under Medicaid law, and intermediate care facility for the individuals with intellectual and developmental disabilities, a long-term care hospital, and inpatient psychiatric facility, or certain other facilities specified by CMS

NOTE: Institutional Equivalent (IE) SNPs enroll MA-eligible individuals who live in the community but require an institutional level of care (I.e., are determined by an impartial entity to need the level of services furnished by the types of facilities listed above). Eligibility for an IE-SNP may be limited to certain Assisted Living Facilities.