What is a Medicare Special Needs Plan and Who Qualifies for One?

Posted by Roman Gomez
Estimated Reading Time 1 minute 16 seconds

Medicare plans are plentiful, and we are always happy to help you shop for a plan that meets your precise needs. But most plans are organized similar to other network-based health insurance plans, based upon a network of general providers and facilities. For those with very unique medical needs, it’s possible that neither Original Medicare nor a Medicare Advantage plan will make a good fit. In those cases, a Special Needs Plan might be a better option.

Special Needs Plans are Medicare Advantage plans that are only open to people with certain circumstances or diagnoses. Your provider network, benefits, and even your drug formulary will be tailored specifically to your needs, helping you to better manage your care.

Who is eligible to enroll in a Special Needs Plan?

• People who live in nursing homes or require nursing care at home.
• Those who are eligible for both Medicare and Medicaid
• Patients with specific conditions (like diabetes, end-stage renal disease, chronic heart failure, HIV/AIDS, or dementia, for example)
• Certain groups of related conditions might qualify you for a SNP.

Why choose a Special Needs Plan?

On a Special Needs Plan, you will have access to a care coordinator, who can help you make choices about your medical care. All SNPs must provide drug coverage, and the formulary is more likely to benefit you than a standard Part D plan.

You might require a referral to see a specialist on some SNPs, while others allow you to make appointments with the specialists of your choice.

For more information on a Special Needs Plan that suits your specific needs, call us to speak with one of our licensed agents. We can help you determine if you’re eligible for this type of Medicare plan, and if the plan’s structure and benefits are right for you.