Special Needs Plan

Meeting Unique Healthcare Needs

In recognition of the diverse medical requirements individuals may face, Medicare Special Needs Plans (SNPs) were developed to offer specialized care tailored to specific conditions or circumstances.

SNPs, categorized as Advantage Plans, are meticulously designed to cater to the needs of individuals dealing with particular health conditions or situations. These plans align their network, benefits, and drug formulary with the patient's condition to ensure appropriate support. Moreover, many SNP plans provide care coordinators who assist patients in managing their condition, adhering to physician directives, accessing community resources, and securing timely prescriptions.

Eligibility Criteria for Chronic Illness SNPs

To qualify for a Chronic Illness SNP, Medicare beneficiaries must have been diagnosed with one or more of the following chronic conditions:

  • Autoimmune disorders

  • Alzheimer’s or dementia

  • Cancer

  • Cardiovascular disease, stroke, or chronic heart failure

  • Diabetes

  • End-stage renal disease requiring dialysis

  • Hematologic disorders

  • HIV or AIDS

  • Chronic lung disorders (e.g., COPD)

  • Chronic or disabling mental illness

  • Neurologic conditions

Chronic Illness SNPs availability may vary by location, as insurance companies determine plan availability based on geographical regions. Hence, not all patients with chronic conditions may find a suitable plan in their area. Additionally, relocating to a different coverage area impacts eligibility. Licensed insurance professionals can assist in locating appropriate plans.

Other Types of Special Needs Plans

In addition to Chronic Illness SNPs, there are Institutional SNPs and Dual-Eligible SNPs. Institutional SNPs cater to patients expected to be institutionalized for 90 days or longer, coordinating care for those no longer living independently.

Dual-Eligible Special Needs Plans

Dual-Eligible SNPs, available to individuals qualifying for both Medicare and Medicaid, often have Medicaid covering premiums and a substantial portion of co-pays and deductibles.

Key benefits of Dual-Eligible SNPs include telemedicine services, transportation to appointments and pharmacies, dental, hearing, and vision benefits, gym memberships, and quarterly benefits for over-the-counter products.

Enrollment in any SNP is based on geographical location, and individuals must maintain enrollment in Original Medicare. Part B premiums are typically paid to Social Security unless Medicaid covers them. The SNP charges a separate premium, and patients are responsible for co-pays and deductibles as outlined by the plan.

Those becoming eligible for an SNP at any time during the year qualify for a Special Enrollment Period, enabling them to select an appropriate SNP.