CMS-SNP Guidance

Special Needs Plans must comply with all Medicare Advantage rules except where the law provides for variance or CMS has the authority to modify rules. Key differences between SNPs and standard MA plans include the following:

  • SNPs can limit enrollment to targeted special needs individuals.
  • Dually eligible and institutionalized beneficiaries may enroll and disenroll throughout the year.
  • Beneficiaries who qualify for a chronic condition SNP have a one-time enrollment option outside of standard enrollment periods.
  • SNPs integrating Medicare and Medicaid benefits may target enrollment to certain subsets of dual beneficiaries.
  • All SNPs must offer Part D coverage.

Section 3205 of the Patient Protection and Affordable Care Act extended the SNP program through December 31, 2013 and subsequent extensions including the Medicare Access and CHIP Reauthorization Act of 2015 has extended SNPs through December 31, 2018. For more information, see CMS website at: (link to external site).