Medicare · Cornerstone
Medicare Special Needs Plans (SNPs): D-SNP, C-SNP, and I-SNP for 2027
Last reviewed October 12, 202612 min readBy the Goodsurance editorial team Reviewed by the Goodsurance editorial team
A Medicare Special Needs Plan (SNP) is a kind of Medicare Advantage plan. It is only for people in one of three groups. A D-SNP is for people with both Medicare and Medicaid. A C-SNP is for people with certain long-term illnesses. An I-SNP is for people who need nursing home level care. This page shows who qualifies for each, the full CMS list of C-SNP conditions, and how SNP care works.
1The short version
If you only read one part of this page, read this.
The short version
An SNP is a Medicare plan, not Medicaid
It is a kind of Medicare Advantage plan. A D-SNP also works with your Medicaid.
There are three kinds
D-SNP for Medicare and Medicaid. C-SNP for certain long-term illnesses. I-SNP for nursing home level care.
You need Part A and Part B
You must also live where the plan is offered. Not every area has every kind.
Every SNP covers your drugs
Part D is built in. What you pay for covered drugs is capped each year: $2,100 in 2026 and $2,400 in 2027.
A care team is part of the deal
The plan checks your needs, writes a care plan with you, and checks in at least once a year.
You have to keep qualifying
If you stop qualifying, you may have to leave. You get a special chance to pick new coverage.
2What makes an SNP different from other Medicare Advantage plans
Most Medicare Advantage plans are open to anyone with Part A and Part B who lives in the area. An SNP is not. It only takes people in the group it was built for. That lets the plan shape its doctors, its drug list, and its extra help around that group.
An SNP still works like other Medicare Advantage plans. It covers everything Part A and Part B cover. It is an HMO or a PPO, so it has a network. You may need approval before some care, and you may need a referral to see a specialist. Each plan is a little different, so check before you join.
Two rules apply to every SNP. It must include Medicare drug coverage (Part D). And it must give you care coordination, which means a team that helps your care fit together. Section 8 explains how that works.
Here is how the three types compare.
| At a glance | D-SNP | C-SNP | I-SNP |
|---|---|---|---|
| Who it is for | People with Medicare and Medicaid | People with a condition on the CMS list | People who need nursing home level care for 90 days or more |
| How the plan checks | Your Medicaid card, a state letter, or a state records check | Your doctor confirms the condition | A state care assessment or a letter from the facility |
| Main job of the plan | Make Medicare and Medicaid work together | Doctors, drugs, and care built around the condition | Care brought to where you live |
| When you can join | With full Medicaid: once a month into an integrated D-SNP | Any time, one time, if a C-SNP serves your condition | While you live in the facility, and 2 full months after you leave |
| Drug coverage (Part D) | ✓ | ✓ | ✓ |
Sources: CMS Special Needs Plans pages; Medicare Managed Care Manual, chapter 16b; Medicare.gov, Special Enrollment Periods.
3D-SNP: for people with both Medicare and Medicaid
The D stands for "dual eligible." That means you have Medicare and also get help from your state Medicaid program. Having both can mean two sets of rules and two cards. A D-SNP is built to make the two work together.
What it costs you. If you have Medicare and Medicaid, most of your costs are usually covered. Some plans charge a premium. If you are in the QMB program, doctors may not bill you for Medicare deductibles or copays.
Who can join. You need Medicaid at one of the levels below. Each D-SNP has a contract with your state. That contract says which levels the plan takes, so not every D-SNP takes every level. The plan checks your Medicaid with your state before you join.
Medicaid levels a D-SNP may accept
Full Medicaid
You get full Medicaid benefits from your state.
QMB (Qualified Medicare Beneficiary)
Pays your Part B premium and your Medicare deductibles and copays. Doctors may not bill you for those.
SLMB (Specified Low-Income Medicare Beneficiary)
Pays your Part B premium only.
QI (Qualifying Individual)
Pays your Part B premium. You must apply again every year.
QDWI (Qualified Disabled and Working Individual)
Pays the Part A premium for some people with a disability who went back to work.
4Integrated D-SNPs: how closely the plan works with Medicaid
D-SNPs come in three levels. The level depends on how much of your Medicaid the plan covers itself.
An integrated D-SNP covers some or all of your Medicaid benefits too. That can mean one card, one company to call, and one way to appeal. If you have full Medicaid, you can join or switch to an integrated D-SNP once a month. The change starts on the first day of the next month.
Not every D-SNP is integrated. Ask the plan, or call 1-800-MEDICARE for a list of integrated D-SNPs near you.
- One company covers Medicare and Medicaid
- Includes long-term care and behavioral health
- The company also holds a Medicaid contract
- Covers long-term care or behavioral health
- Your Medicaid benefits are mostly handled outside the plan
- The plan tells your state about hospital and nursing home stays
5C-SNP: the chronic conditions that qualify
The C stands for "chronic condition." A C-SNP is for people with a serious, long-term illness from a list set by CMS, the federal agency that runs Medicare. A plan can serve one condition, such as diabetes. Or it can serve a group of linked conditions, such as diabetes and heart failure. You only need one of the conditions in the group.
Here is the full CMS list. For some conditions, only the ones named count.
The 15 conditions CMS lists for C-SNPs
1. Chronic alcohol and other drug dependence
Long-term alcohol or drug use disorder.
2. Autoimmune disorders
Only these: polyarteritis nodosa, polymyalgia rheumatica, polymyositis, rheumatoid arthritis, systemic lupus erythematosus.
3. Cancer
Not pre-cancer, and not cancer "in situ" (cancer that has not spread).
4. Cardiovascular disorders
Only these: cardiac arrhythmias, coronary artery disease, peripheral vascular disease, chronic venous thromboembolic disorder.
5. Chronic heart failure
Long-term heart failure.
6. Dementia
A long-term loss of memory and thinking skills.
7. Diabetes mellitus
Type 1 or type 2 diabetes.
8. End-stage liver disease
Liver failure.
9. End-stage renal disease (ESRD) that needs dialysis
Kidney failure treated with dialysis.
10. Severe blood disorders
Only these: aplastic anemia, hemophilia, immune thrombocytopenic purpura, myelodysplastic syndrome, sickle cell disease (not sickle cell trait), chronic venous thromboembolic disorder.
11. HIV/AIDS
HIV infection or AIDS.
12. Chronic lung disorders
Only these: asthma, chronic bronchitis, emphysema, pulmonary fibrosis, pulmonary hypertension.
13. Chronic and disabling mental health conditions
Only these: bipolar disorders, major depressive disorders, paranoid disorder, schizophrenia, schizoaffective disorder.
14. Neurologic disorders
Only these: ALS, epilepsy, extensive paralysis, Huntington's disease, multiple sclerosis, Parkinson's disease, polyneuropathy, spinal stenosis, nerve damage from a stroke.
15. Stroke
Also called a cerebrovascular accident.
6How a C-SNP checks your condition
Before you join, the plan must check with your doctor that you have the condition. Often the plan sends your doctor a short form. The doctor marks your condition on it.
Some plans use a CMS-approved question form instead. You answer questions about your health, and a doctor signs it. If the plan uses this form, it must still get your doctor to confirm the condition by the end of your first month. If it cannot, it must tell you in the first 7 days of your second month. Your coverage then ends at the end of that second month.
CMS also approves five groups of linked conditions that a C-SNP can serve:
- Diabetes and chronic heart failure
- Chronic heart failure and cardiovascular disorders
- Diabetes and cardiovascular disorders
- Diabetes, chronic heart failure, and cardiovascular disorders
- Stroke and cardiovascular disorders
7I-SNP: for people who need nursing home level care
The I stands for "institutional." An I-SNP is for people who need the care of a nursing home, or a similar place, for 90 days or more. That can mean you have had that care for 90 days. Or it can mean you are expected to need it that long. A letter from the nursing home or a state care assessment can show this.
Some I-SNPs also take people who live at home but need that same level of care. A state tool decides that, and someone outside the plan must do the check.
The goal is care that comes to you, so you do not have to leave for routine visits. If you live in a facility, make sure the plan has providers who serve it.
What it does not pay for. Medicare does not pay for long-term custodial care. That is help with daily tasks like bathing and dressing. An I-SNP covers your medical care. Medicaid or your own money usually pays for the room and daily help.
8How SNP care management works
Care management is the main thing an SNP adds. Federal rules say every SNP must follow a "model of care." That is a written plan for how it will care for its members, and CMS must approve it.
First, a health risk assessment. The plan must do this within 90 days before or after your coverage starts. It asks about your health, your daily needs, and your mood. It must also ask about housing, food, and getting rides. The plan must try at least three times to reach you. You can say no.
Next, your care plan. Within 90 days, the plan writes a care plan with you. It lists your goals and the services you will get. A team of doctors, nurses, and other staff builds it with you. The plan updates it when your health changes, such as after a hospital stay.
Then, every year. The plan does a new assessment each year. It also offers at least one visit a year with someone from your care team, if you agree. The visit can be in person or by live video.
How SNP care management works, step by step
Source: federal rules for SNPs, 42 CFR 422.101(f).
Care management words, in plain English
Model of care (MOC)
The plan's written playbook for caring for its members. CMS must approve it.
Health risk assessment (HRA)
Questions about your health, your daily needs, and your mood. It also asks about housing, food, and rides.
Individualized care plan (ICP)
Your goals and the services you will get. It changes when your health changes.
Interdisciplinary care team (ICT)
Doctors, nurses, and other staff who plan your care together, with you.
Face-to-face visit
At least once a year, in person or by live video, if you agree.
9Extra benefits, and the "grocery card"
Many SNPs offer extra benefits. Some are for members with chronic illnesses who meet the plan's rules. These can include help paying for food and produce, utilities, or rides. The money is often loaded on a card you use at certain stores.
This is not a Medicare benefit everyone gets. Each plan decides what it offers, how much, and who qualifies. SNPs are more likely than other plans to offer it. In 2026, KFF found food and produce help in 85% of SNPs, compared with 11% of plans open to everyone. See what the Medicare "grocery card" really is.
SNPs also have some cost limits. Your plan cannot charge more than Original Medicare for chemotherapy, dialysis, and skilled nursing facility care.
10When you can join or leave an SNP
You can join any Medicare Advantage plan, SNPs included, during the yearly Open Enrollment Period, October 15 to December 7. SNPs also have special times to join, called Special Enrollment Periods.
- C-SNP: if you have a qualifying condition and a C-SNP serves it, you can join at any time. You can use this chance one time.
- D-SNP: if you have Medicaid or Extra Help, you can change your drug coverage once a month. If you have full Medicaid, you can join or switch to an integrated D-SNP once a month.
- I-SNP: you can join, switch, or drop a plan while you live in a nursing home, and for 2 full months after you move out.
Changes made with a monthly Special Enrollment Period start on the first day of the next month.
You can stay in an SNP only while you still qualify. If you lose Medicaid but are expected to get it back, a D-SNP may keep you for up to 6 months. If you no longer qualify, you get a Special Enrollment Period to choose new coverage. It lasts until you join a new plan, or up to 3 months after the SNP ends your coverage.
11How to find SNPs in your county
Insurance companies choose where to offer SNPs, and the choices change each year. So the first step is seeing what is offered where you live.
Want the quick answers? See who qualifies for a Special Needs Plan and what a D-SNP is. To see how SNPs fit with other plans, read Medicare Advantage, explained.
How to find SNPs where you live
1. Use Medicare.gov's Plan Finder
Enter your ZIP code to see the Medicare Advantage plans in your area, including SNPs.
2. Or call 1-800-MEDICARE
Ask which SNPs serve your county. For a D-SNP, ask which ones are integrated. TTY 1-877-486-2048.
3. Check your doctors and drugs
Make sure the plan's network has your doctors. Make sure your drugs are on its list.
4. Get free help from your SHIP
Your State Health Insurance Assistance Program gives free, unbiased advice. Find yours at shiphelp.org.
Common questions about Medicare
Quick answers to common questions
Tap any question to expand. Each question links to a fuller standalone answer.
Is an SNP Medicare or Medicaid?
An SNP is a Medicare plan. It is a kind of Medicare Advantage plan run by a private company. A D-SNP is for people who also have Medicaid, and it works with your state Medicaid program, but it is still a Medicare plan.
Who qualifies for a Medicare Special Needs Plan?
You need Part A and Part B and must live in the plan's area. You must also fit one group: you have Medicare and Medicaid (D-SNP), you have a condition on the CMS list (C-SNP), or you need nursing home level care for 90 days or more (I-SNP).
What chronic conditions qualify for a C-SNP?
CMS lists 15: alcohol or drug dependence, some autoimmune disorders, cancer, some heart and blood vessel disorders, chronic heart failure, dementia, diabetes, end-stage liver disease, ESRD on dialysis, some severe blood disorders, HIV/AIDS, some lung disorders, some serious mental health conditions, some neurologic disorders, and stroke.
What is the difference between a D-SNP, a C-SNP, and an I-SNP?
They serve different people. A D-SNP is for people with Medicare and Medicaid. A C-SNP is for people with a qualifying chronic condition. An I-SNP is for people who need nursing home level care. All three include drug coverage and a care team.
How does care management work in an SNP?
The plan does a health risk assessment within 90 days of when you join. Then it writes a care plan with you, and a team of doctors and nurses follows it. The plan checks your needs again every year and offers at least one visit a year with your care team.
What is a model of care?
It is the plan's written plan for how it will care for its members. Every SNP must have one, and CMS must approve it. It covers the health risk assessment, your care plan, your care team, and how the plan helps you move between settings like a hospital and home.
Do SNPs include prescription drug coverage?
Yes. Every SNP must include Medicare drug coverage (Part D). What you pay for covered drugs is capped each year: $2,100 in 2026 and $2,400 in 2027.
Is the Medicare grocery allowance real?
Not as a Medicare benefit for everyone. Some Medicare Advantage plans, mostly SNPs, offer help with food for members with chronic illnesses who meet the plan's rules. Each plan sets the amount and who qualifies.
When can I join an SNP?
During Open Enrollment, October 15 to December 7, like any Medicare Advantage plan. You can also join a C-SNP once at any time if it serves your condition. With full Medicaid, you can join an integrated D-SNP once a month. In a nursing home, you can join while you live there.
What happens if I lose Medicaid while I am in a D-SNP?
If you are expected to get Medicaid back, the plan may keep you for up to 6 months. If you do not get it back, you get a Special Enrollment Period to choose new coverage. Your Medicaid help with costs stops while you do not have Medicaid.
Do I need Part B to join an SNP, or does it replace Part B?
You need both Part A and Part B to join any Medicare Advantage plan, SNPs included. You keep paying your Part B premium unless Medicaid or a Medicare Savings Program pays it for you.
How does a person under 65 get Medicare for a disability?
Most people get Medicare after 24 months of Social Security disability benefits. People with ALS or kidney failure have their own timing. Once you have Part A and Part B, you can join an SNP if you qualify for one.
References
- CMS: Special Needs PlansWhat an SNP is; every SNP must include Part D drug coverage.
- CMS: Chronic Condition Special Needs Plans (C-SNPs)The 15 SNP-specific chronic conditions and the five approved condition groups.
- CMS: Dual Eligible Special Needs Plans (D-SNPs)D-SNP rules and integration levels.
- CMS: Institutional Special Needs Plans (I-SNPs)Who can join an I-SNP.
- CMS: SNP Model of CareThe care plan every SNP must have approved.
- CMS: Medicare Managed Care Manual, Chapter 16b, Special Needs Plans (Rev. 131, Nov. 2024)Condition list (20.1.2), D-SNP levels (20.2.1), I-SNP 90-day rule (20.3.1), eligibility checks (40.2), deemed continued eligibility (20.2.4.2.3).
- eCFR: 42 CFR 422.101(f), SNP model of careHealth risk assessment within 90 days, care plan, care team, yearly visit.
- Medicare.gov: Special Needs Plans (SNP)Who can join, costs, drug coverage, staying enrolled.
- Medicare.gov: Special Enrollment PeriodsWhen people with Medicaid, a chronic condition, or nursing home care can join or switch.
- Medicare.gov: Medicare Savings ProgramsWhat QMB, SLMB, QI, and QDWI pay for.
- Medicare.gov: Long-term careMedicare does not pay for long-term custodial care.
- Medicare.gov: How much does Medicare drug coverage cost?The Part D out-of-pocket cap: $2,100 in 2026, $2,400 in 2027.
- CMS: Special Supplemental Benefits for the Chronically Ill (HPMS memo, April 2019)Food and produce and other extras plans may offer.
- KFF: Medicare Advantage 2026 SpotlightShare of SNPs and other plans offering food and produce benefits in 2026.