Medicare Special Needs Plans (SNPs): How D-SNPs, C-SNPs and I-SNPs Work

Source: Medicare.gov: Special Needs Plans (SNP)

This guide explains the three types of Medicare Special Needs Plans, who each one serves, what's the same as other Medicare Advantage plans, and when you can join. We don't show prices or recommend a plan; we explain how SNPs work so you can ask the right questions.

New to Medicare Advantage? Start with What is Medicare Part C? and come back here.

What is a Medicare Special Needs Plan?

A Special Needs Plan is a Medicare Advantage plan that provides benefits and services to people with specific severe and chronic diseases, certain health care needs, or who also have Medicaid. SNPs include care coordination services and tailor their benefits, provider choices and drug lists (formularies) to the needs of the groups they serve (Medicare.gov).

SNPs are either HMO or PPO plan types, and they cover the same Part A and Part B benefits that all Medicare Advantage plans cover. They may also cover extra services for the groups they serve. For example, Medicare.gov notes that if you have a severe condition, like cancer or congestive heart failure, and you need a hospital stay, an SNP may cover extra days in the hospital. If you need hospice care, Original Medicare covers it even while you're in a Medicare Advantage plan.

The 3 types of Special Needs Plans

Dual Eligible SNP (D-SNP)

D-SNPs enroll people who have both Medicare and medical assistance from their state's Medicaid program (CMS). CMS counts full Medicaid and the Medicare Savings Program groups, such as Qualified Medicare Beneficiary (QMB) and Specified Low-Income Medicare Beneficiary (SLMB), among the Medicaid eligibility categories. A plan may serve all of these groups or only some of them, so ask which ones it serves.

D-SNPs, including integrated D-SNPs, can help coordinate your benefits between Medicare and Medicaid. If you have Medicare and Medicaid, Medicare.gov notes that most of your costs will be covered for you; your Medicaid office can tell you more. See Medicare Savings Programs in Utah and Medicaid income limits in Utah.

Chronic Condition SNP (C-SNP)

C-SNPs are for people with a severe or disabling chronic condition, as specified by CMS (CMS). A C-SNP can limit membership to a single chronic condition or a group of related chronic conditions, so the plan's eligibility rules tell you which conditions it serves.

Institutional SNP (I-SNP)

I-SNPs are for people who, for 90 days or longer, have had or are expected to need the level of services provided in a long-term care facility, such as a skilled nursing facility, a nursing facility, an intermediate care facility for individuals with intellectual disabilities, or an inpatient psychiatric facility (CMS). Some I-SNPs also enroll people who live in the community but need an institutional level of care, based on a state assessment. If you're interested in an I-SNP and live in a facility, Medicare.gov suggests checking that the plan has providers that serve people where you live.

Who can join a Special Needs Plan?

You can join an SNP if you meet all of these requirements (Medicare.gov):

• You have Medicare Part A and Part B.
• You live in the plan's service area.
• You meet the eligibility requirements for one of the 3 types of SNPs, or a subset of one of these groups.

Insurance companies decide where they'll do business, so SNPs may not be offered everywhere, and the SNP types available can change from year to year. You can see the SNPs offered in your Utah county in Medicare Plan Finder.

What's the same as other Medicare Advantage plans

• Part A and Part B benefits: SNPs cover the same Part A and Part B benefits that all Medicare Advantage plans cover.
• Drug coverage: every SNP must include Medicare drug coverage (Part D).
• Premiums: they vary by plan. Some plans may charge a premium in addition to your monthly Part B premium.
• Networks: they vary by plan. Some SNPs require you to use the plan's network (except emergency care, out-of-area urgent care or out-of-area dialysis); some offer out-of-network coverage, usually at a higher cost.
• Primary care doctor and referrals: these vary by plan. If you have a doctor you like, ask the plan whether you can keep them.
• Medigap: Medigap can't be used with a Medicare Advantage plan, including an SNP.

Compare the 3 SNP types

Pick a Special Needs Plan type to see who it serves, what it focuses on and what to check, from Medicare.gov and CMS.

When can you join or leave a Special Needs Plan?

You can join an SNP during the usual Medicare Advantage windows: when you're first eligible, and every fall during Medicare Open Enrollment (October 15 to December 7). Some Special Enrollment Periods also apply (Medicare.gov):

• C-SNP: if you have a severe or disabling condition and a C-SNP serves people with that condition, you can join it any time. Once you join, your chance to make changes using this Special Enrollment Period ends.
• Integrated D-SNP: if you have Medicare and full Medicaid benefits, you can join or switch to an integrated D-SNP once a calendar month, if one is available in your area.
• You no longer qualify: if you're in an SNP and no longer have a condition the plan serves, you can join a Medicare drug plan or another type of Medicare Advantage plan. Your chance starts the month you lose your special needs status and ends when you join another plan or 3 calendar months after the effective date of your involuntary disenrollment, whichever is earlier.

See Medicare Special Enrollment Periods for other life events.

How to look at Special Needs Plans in your county

For the Utah picture, see Medicare Advantage plans in Utah. To compare plan types, see Medicare Advantage HMO vs PPO. To weigh Medicare Advantage against Original Medicare with a Medigap policy, see Medicare Advantage vs. Medicare Supplement or try our Original Medicare vs. Medicare Advantage comparison tool. For how timing works, see turning 65 in Utah, Medicare enrollment dates and the Medicare Advantage Open Enrollment Period.

How our team helps

We're Boo Insurance Services, a licensed independent Medicare agency in Draper, licensed since 2014. We can show you options from more than one company. The plans we can show you don't include Institutional Special Needs Plans (I-SNPs); to see I-SNPs where you live, use Medicare Plan Finder or call 1-800-MEDICARE. We've helped 1,000+ Utahns with Medicare and have 170+ 5-Star Google Reviews. Appointments are by phone or video, anywhere in Utah. You won't pay us a fee. Insurance companies pay us when you enroll, and that doesn't change your plan's benefits, coverage or premium. Before we talk about specific plans, you'll confirm what we'll discuss with a short Scope of Appointment form, which Medicare rules require. You decide, with no obligation.

Frequently asked questions

What is a Medicare Special Needs Plan?

A Special Needs Plan (SNP) is a type of Medicare Advantage plan for people with specific severe or chronic conditions, certain health care needs, or who also have Medicaid. SNPs include care coordination and tailor their benefits, provider choices and drug lists to the groups they serve.

Who can join a Medicare Special Needs Plan?

You can join if you have Medicare Part A and Part B, live in the plan's service area, and meet the eligibility requirements for the plan's SNP type, or a subset of that group.

What is a D-SNP?

A Dual Eligible Special Needs Plan (D-SNP) is for people who have both Medicare and Medicaid. D-SNPs, including integrated D-SNPs, can help coordinate your benefits between Medicare and Medicaid.

What is a C-SNP?

A Chronic Condition Special Needs Plan (C-SNP) is for people with a severe or disabling chronic condition, as specified by CMS. A C-SNP can limit membership to a single chronic condition or a group of related chronic conditions.

What is an I-SNP?

An Institutional Special Needs Plan (I-SNP) is for people who, for 90 days or longer, have had or are expected to need the level of care provided in a long-term care facility, such as a skilled nursing facility or nursing facility. Some I-SNPs also serve people living in the community who need that level of care, based on a state assessment.

Do Special Needs Plans include prescription drug coverage?

Yes. All SNPs must provide Medicare drug coverage (Part D).

When can I join a Special Needs Plan?

During the usual Medicare Advantage windows, such as when you're first eligible and during Medicare Open Enrollment, October 15 to December 7. If you have a qualifying condition, you can join a C-SNP that serves it any time, and if you have Medicare and full Medicaid benefits, you can join an integrated D-SNP once a calendar month, where one is available.

What happens if I no longer qualify for my Special Needs Plan?

If you no longer qualify, the plan will tell you, and you may have a period of time to stay in the plan and a Special Enrollment Period to make a change. That Special Enrollment Period lets you join a Medicare drug plan or another type of Medicare Advantage plan.

Serving Utah residents. We do not offer every plan available in your area. Currently we represent 9 organizations which offer 58 products in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

Sources

• Medicare.gov, Special Needs Plans (SNP)
• Medicare.gov, Special Enrollment Periods
• CMS, Special Needs Plans
• CMS, Dual Eligible Special Needs Plans (D-SNPs)
• CMS, Institutional Special Needs Plans (I-SNPs)

Not connected with or endorsed by the United States government or the federal Medicare program. Fores Boo, licensed independent Medicare agent, NPN 17255694, Boo Insurance Services, 61 W 13490 S Ste 201, Draper, UT 84020.

Last updated: October 21, 2026.