A Medicare Special Needs Plan (SNP) is a Medicare Advantage plan created for individuals with specific needs in order to provide coordinated care. These plans have certain qualifications, expand and specialize coverage, and differ from traditional Medicare Advantage plans.

Who Qualifies for a Special Needs Plan?

To qualify for a Medicare Advantage Special Needs Plan you must meet one of the following requirements:

  • Be enrolled in both Medicare and Medicaid, called dual eligibility;
  • Be in a long term care facility for longer than 90 days; OR
  • Have a chronic illness

When Can I Enroll in a Medicare SNP?

You can either enroll in a Medicare Special Needs Plan if you meet one of the qualifications above during your 7-month initial enrollment period or at any time if you newly qualify for an SNP. You may also choose to switch your SNP or enroll during MA plan Open Enrollment each year. If your situation changes, such as you no longer qualify for Medicaid, you must disenroll from your SNP and either enroll in Original Medicare or a traditional Medicare Advantage plan.

Not all states and areas offer SNP plans/are required to offer all three types of Special Needs Plans: Dual Eligibility, Institutional, and Chronic Condition.

How do Medicare SNPs work?

Medicare Special Needs Plans are HMO plans that a curtailed to your special needs whether you have diabetes, Alzheimer’s, substance dependence, chronic heart disease, and other chronic illness. SNPs offer the following extended benefits to its beneficiaries:

  • $0 or lower beneficiary cost sharing
  • Longer benefit coverage for inpatient care
  • Longer benefit coverage periods for specialty medical services

Medicare Advantage vs. Medicare Advantage SNP

There are a few differences between a traditional Medicare Advantage plan and a Medicare Advantage Special Needs plan. The following must be allowed or included in a Medicare SNP:

  • You CAN enroll in a SNP if you have End Stage Renal Disease (traditional MA plans exclude this)
  • All SNPs must include prescription drug coverage
  • Plans are specific to your needs (unless just for dual eligibility)
  • You CAN enroll in a Medigap plan while enrolled in Medicare Advantage SNP (it is illegal to enroll in a traditional Medicare Advantage plan and Medigap at the same time)

To learn if you qualify for a Medicare Special Needs Plan call the number above or contact Senior65.com.