Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage Plan (like an HMO or PPO). SNPs were created by Congress in the Medicare Modernization Act (MMA) of 2003, as a new type of Medicare managed care plan that focus on certain vulnerable groups of Medicare beneficiaries. Medicare SNPs limit membership to people with specific diseases or characteristics, and tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve. Unlike other types of MA plans, SNPs can limit enrollment to the following subgroups:
- Dual-Eligible SNPs (D-SNP) enroll beneficiaries eligible for Medicare and Medicaid.
- Institutional SNPs (I-SNP) enroll beneficiaries who are institutionalized or are determined by use of a State assessment tool, to meet institutional level of care. Those that meet the institutional level of care can live in the community and be enrolled in the I-SNP.
- Chronic SNPs (C-SNP) enroll beneficiaries with certain chronic or disabling conditions.
The MMA stated that SNPs should emphasize monitoring health status, managing chronic diseases, avoiding inappropriate hospitalizations and helping beneficiaries maintain or improve their health status.