Las Vegas, Nevada

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Play Video about Special Needs Plans

Special Needs Plans

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

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

The plan 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:

  • 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 (such as COPD)
  • Chronic or disabling mental illness
  • Neurologic conditions

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 the premiums, along with a significant portion of co-pays and deductibles.

The benefits of a DSNP include the following:

  • Telemedicine services
  • Transportation to appointments and pharmacies
  • Dental, hearing, and vision benefits
  • Gym memberships
  • Quarterly benefits for over-the-counter products

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.

Important

If you don’t enroll in Medicare Part D when you are first eligible for Medicare, you can elect a plan later. However, late penalties may apply. Each year, during Medicare’s Annual Election Period from October 15 to December 7, you can add, drop, or change your plan selections.