Special Needs Plan
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A special needs plan (or SNP, often pronounced "snip") is a category of the US
Medicare Advantage Medicare Advantage (Medicare Part C, MA) is a capitated program for providing Medicare benefits in the United States. Under Part C, Medicare pays a private-sector health insurer a fixed payment. The insurer then pays for the health care expenses ...
plan designed to attract and enroll Medicare beneficiaries who fall into a certain special needs demographic. There are two types of SNPs. The exclusive SNP enrolls only those beneficiaries who fall into the special needs demographic. The other type is the disproportionate share SNP. "Disproportionate share" SNPs enroll a greater percentage of the target special needs population as compared to a national percentage of the target population. Under the federal
Medicare Prescription Drug, Improvement, and Modernization Act The Medicare Prescription Drug, Improvement, and Modernization Act, also called the Medicare Modernization Act or MMA, is a federal law of the United States, enacted in 2003. It produced the largest overhaul of Medicare in the public health progr ...
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, defined as individuals who are entitled to Medicare Part A and/or Part B and are eligible for some form of
Medicaid Medicaid in the United States is a federal and state program that helps with healthcare costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, including nursing home care and pers ...
benefit. *Beneficiaries with chronic conditions, defined as individuals who have acquired one or more disabling chronic conditions, including, but not limited to:
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References

*{{cite web , url=https://www.cms.gov/Medicare/Health-Plans/SpecialNeedsPlans/index.html , title=Special Needs Plans , website= Centers for Medicare & Medicaid Services , access-date= 22 April 2017 Health economics Medicare and Medicaid (United States)