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A special needs plan (SNP) is a type of Medicare Advantage plan for people with special health care needs. There are three types: Dual-Eligible SNPs, Chronic Condition SNPs and Institutional SNPs.
Each type of SNP covers benefits specific to the population that qualifies for it. All SNPs cover the benefits included in Medicare Part A and Part B.
Here’s what you should know about Medicare special needs plans.
What are the three types of Medicare special needs plans?
There are three types of Medicare special needs plans that serve different populations:
- Chronic Condition SNPs cover beneficiaries with specific chronic conditions. There’s a list of 15 types of conditions that qualify, and many of the 15 have a number of subtypes.
- Institutional SNPs cover beneficiaries who will need long-term care, skilled nursing care or similar institutional care from certain kinds of facilities for 90 days or longer.
Each SNP type has its own rules for eligibility and benefits. Rules can also vary by state and/or the health insurance company administering the plan.
Compare Medicare Advantage plans
| Insurance company | NerdWallet rating | States available | Members in high-rated plans | Member experience |
|---|---|---|---|---|
| 48 states and Washington, D.C. | Medium (50% to 84%) | 3.74 (Average) | ||
| 46 states and Washington, D.C. | Low (49% or less) | 3.82 (Above average) | ||
| 43 states and Washington, D.C. | Medium (50% to 84%) | 3.89 (Above average) | ||
| 29 states and Washington, D.C. | Medium (50% to 84%) | 3.96 (Above average) |
What are the benefits of a Medicare special needs plan?
All SNPs include the same benefits covered by Medicare Part A and Part B, plus Medicare Part D prescription drug coverage.
Beyond those standard benefits, additional SNP benefits vary by plan type and health insurance company. Here are examples of benefits that each type could include:
- D-SNPs might cost little or nothing out of pocket and might offer help coordinating benefits between Medicare and Medicaid.
- Chronic Condition SNPs might offer special programs to help manage specific conditions or access to a provider network specializing in certain conditions.
- Institutional SNPs might help coordinate home-based, community-based and institution-based services.
There are also some potential drawbacks to SNPs. For example, your plan might deny services or charge more for out-of-network care, and you might need to get referrals to see specialists.
When shopping, check the plan materials for the specifics to be sure you can get the care you need within the applicable limitations.
How do you qualify for a Medicare special needs plan?
To qualify for an SNP, you must have both Medicare Part A and Medicare Part B, live in the plan’s service area and meet the type-specific requirements.
Each type of SNP has its own eligibility requirements:
Dual-Eligible SNPs
People who qualify for both Medicare and Medicaid are eligible to join a D-SNP.
Medicaid eligibility is mostly based on income. But it’s possible to qualify for other reasons, such as receiving Supplemental Security Income (SSI).
States’ Medicaid eligibility rules vary. You can review the criteria for your state on Medicaid.gov.
Chronic Condition SNPs
People with certain medical conditions are eligible to join a Chronic Condition SNP.
There are qualifying conditions in categories including, for example, autoimmune disorders, cancer, cardiovascular disease, end-stage renal disease (ESRD), HIV/AIDS, mental health conditions and neurologic disorders.
You can see the full list of qualifying chronic conditions on Medicare.gov.
Institutional SNPs
People who have had or are expected to need certain institutional-level care for 90 days or more are eligible to join an Institutional SNP.
Examples of qualifying institutions include nursing homes, skilled nursing facilities, long-term care hospitals and psychiatric hospitals.
It’s also possible to qualify for an Institutional SNP if you’re living in the community (not in a facility), but you need facility-level care. There are state-specific assessments to determine eligibility in these circumstances.
Shopping for Medicare Advantage plans? We have you covered.
| MEDICARE ADVANTAGE is an alternative to traditional Medicare offered by private health insurers. Compare options from our Medicare Advantage roundup. | |
| Best major company | Best for size of network |
| Best government ratings | Best for low-cost plan availability |
What do Medicare special needs plans cost?
If you qualify for a D-SNP because you have both Medicare and Medicaid, most of your costs will be covered for you, according to Medicare.gov. If you don’t, the cost of a Medicare special needs plan varies by plan type and health insurance company. A number of Medicare SNPs have low or $0 monthly premiums.
You’ll generally still be responsible for the Medicare Part B premium, which is $202.90 per month in 2026, unless your plan or another program covers some or all of that cost for you.
Other costs such as deductibles, coinsurance and copays are also plan-specific. You can find cost breakdowns in plan materials or compare costs when shopping for SNPs on Medicare’s plan finding tool. (Start by searching for Medicare Advantage plans, then select “View all filters” and check the box to show one or more types of SNPs.)
If you have additional questions about Medicare, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).
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- 1. Centers for Medicare & Medicaid Services. Special Needs Plans (SNP). Accessed Mar 30, 2026.
- 2. Centers for Medicare & Medicaid Services. Dual Eligible Special Needs Plans (D-SNPs). Accessed Mar 30, 2026.
- 3. Centers for Medicare & Medicaid Services. Chronic Condition Special Needs Plans (C-SNPs). Accessed Mar 30, 2026.
- 4. Centers for Medicare & Medicaid Services. Institutional Special Needs Plans (I-SNPs). Accessed Mar 30, 2026.
- 5. Centers for Medicare & Medicaid Services. Medicare Special Needs Plans. Accessed Mar 30, 2026.
- 6. Centers for Medicare & Medicaid Services. Eligibility Policy. Accessed Mar 30, 2026.
