Mbsm Solutions, LLC

Medicare Special Needs Plans (SNPs)

Medicare Special Needs Plans (SNPs)

There Are 3 Types Of SNPs

Dual SNPs Or D‑SNPs

This plan type is designed to enrolled exclusively beneficiaries with Medicare and Medicaid coverage.

Chronic SNPs Or C‑SNPs

This plan type is designed for individuals with specific severe or disabling chronic conditions.

Institutional SNPs Or I‑SNPs

This plan type is designed for Medicare beneficiaries in need of nursing level of care.


Managed Care Organizations (MCO) already contracting with the state Medicaid program coordinate the care for this population through a single plan. Premium and cost sharing payment by Medicaid depends on the level of assistance the beneficiary gets through the Medicare Saving Program (MSP) administered by each state. MSP benefit groups are as follows:


There are currently 15 chronic conditions, defined in chapter 42, part 422 of the Code of Federal Regulations (42 CFR 422.2.), carriers can use to design a C-SNP for a target population. CMS identifies the following 5 commonly co-existing chronic conditions that may be the focus of a C-SNP:

For Medicare Advantage Organizations (MAOs) that are approved to offer a C-SNP targeting one of CMS defined groups, enrollees need to have only one of the qualifying conditions for enrollment.

A carrier that customizes its group based on some of the 15 chronic conditions is required to verify that enrollees have ALL the conditions included in their customized group. A customized group can be limited to a single condition of the list (List of Chronic Conditions.pdf).