Medicare Advantage plans called Special Needs Plans (SNP) are designed to provide customized care to people with specific health conditions.
A Special Needs Plan is a type of Medicare Advantage plan (also called Medicare Part C) that is designed specifically for someone with a particular disease or financial circumstance.
The coverage offered by each SNP is built around providing more narrowly-focused care that better meets the needs of the patient.
Read below to learn more about Special Needs Plans and to find out if this type of coverage may be right for you.
A Special Needs Plan can work similarly to other types of Medicare Advantage plans.
Medicare Advantage plans offer an alternative way to receive Original Medicare benefits (Part A and Part B), and many Medicare Advantage plans offer additional benefits that aren't covered by Original Medicare.
Medicare Advantage plans come in a variety of types such as HMOs and PPOs. While Original Medicare can be used all over the country, most Medicare Special Needs Plans feature a network of participating health care providers, pharmacists and suppliers where the plan may be used.
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As mentioned above, Medicare Advantage plans offer the same benefits covered by Medicare Part A and Part B combined into one plan sold by a private insurance company.
Medicare Advantage Special Needs Plans can also cater more specifically to the needs of people with:
There also Special Needs Plans that can be available to people who reside in a long-term care facility such as a skilled nursing home.
Some Medicare SNPs are designed for people who are dual-eligible, meaning they are eligible for both Medicare and Medicaid.
Each Medicare SNP is designed to offer some unique benefits designed to serve the population for whom that plan is designed.
For example, a Medicare SNP for beneficiaries who have a chronic lung disorder may include:
In addition to the tailored benefits, Special Needs Plans provide all the same basic coverage as Original Medicare. A Medicare Advantage SNP may also offer benefits such as coverage for dental, hearing and vision care, as well as prescription drug coverage.
Special Needs Plans can be particularly beneficial because of their focused coverage benefits.
To be eligible for a Special Needs Plan, you must first be enrolled in Original Medicare and live in the area served by your desired plan.
The additional requirements for each type of SNP plan may also include:
You may enroll in a Medicare SNP during the annual Medicare Open Enrollment Period that runs from October 15 to December 7 every year.
You may also enroll in a Medicare SNP if you are granted a Special Election Period. You may be given a Special Election Period if:
Like other types of Medicare Advantage plans, Medicare SNPs will vary in terms of cost, coverage and availability from one location to the next.
Depending on the plan you have, a Special Needs Plan may include some of the following costs:
The costs tied to Special Needs Plans can vary significantly between one area, plan or insurance carrier to the next. Costs can also depend on whether or not you qualify for financial assistance or are eligible for Medicaid.
Read additional medicare costs guides to learn more about Medicare costs and how they will affect you.
Call today to speak with a licensed insurance agent to review and compare Medicare Special Needs Plans that may be available in your area.
An agent can then help you review the details of each plan, including costs, coverage, network providers, terms, conditions and more so that you can make an informed decision about the best plan for your needs.
Find out if you are eligible, and find a plan that may be the right fit for your unique health care needs.
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism. He currently lives in Raleigh, NC.
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