Medicare Special Needs Plans

Special medical situations require specialized care. Medicare Special Needs Plans (or SNPs) were created with this principle in mind.

SNPs are Medicare Advantage Plans that are tailored to meet the needs of individuals with certain health conditions or circumstances.

The planned network, benefits, and drug formulary are all centered on the patient’s condition in order to provide the appropriate support. Many SNP plans also assign care coordinators to assist patients in managing their condition, following physician orders, accessing community resources and obtaining timely prescriptions.

To qualify for a Special Needs Plan on the basis of chronic illness, the Medicare beneficiary must be diagnosed with one or more of the following conditions:

Chronic illness SNPs vary by geographic area, with insurance companies deciding where certain plan designs are offered. Therefore, not all patients with chronic conditions will be able to locate a plan designed around their needs in their area. Additionally, moving to a new home in a different coverage area will impact eligibility. A licensed insurance professional can offer more assistance in locating these plans.

Some other types of Special Needs Plans include Institutional SNPs and Dual-Eligible SNP. A patient who is expected to be institutionalized for 90 days or longer might be eligible for an Institutional SNP, designed to coordinate the care of a patient no longer living independently.

Dual-Eligible Special Needs Plans

Dual-eligible Special Needs Plans or DSNPs are available to individuals who qualify for both Medicare and Medicaid. In many cases, Medicaid will pay a significant portion of co-pays and deductibles.

The benefits of a DSNP include the following:

Enrollment in any SNP is based upon geographical area, and the individual must maintain enrollment in Original Medicare. Part B premiums will still be paid to Social Security, unless Medicaid eligibility covers those. The SNP will charge a premium separately, and the patient is also responsible for co-pays and deductibles as determined by the plan.

Those who become eligible for a SNP at any point during the year are eligible for a Special Enrollment Period, during which they can select a SNP.