Special Needs Plans

Special Needs Plans is a Medicare Advantage plan exclusively designed to provide limited enrollment and target special care needs. The plan is available to those who already have Medicare Part C.

Under SNP, subscribers have coverage for their doctor’s visits, medications, hospital stays, and other healthcare services. The major difference between SNP and other MA options is that it offers additional services based on the subscriber’s unique health needs, including care management, special social services, and extra days in the hospital.

Types of Special Needs Plans

Chronic-Condition Special Needs Plans (C-SNP): This is a type of Special Needs Plan that helps beneficiaries with certain disabling or severe chronic diseases, such as HIV/AIDS, cancer, or chronic health failure. C-SNP may target a single or more chronic condition.

Dual-Eligible Special Needs Plans (D-SNP): D-SNP helps Medicare beneficiaries who are eligible for both Medicare and Medicaid plans.

Institutional Special Needs Plans (I-SNP): This plan is more suitable for those who need nursing care at home or living in an institution such as a nursing home.

Special Needs Plans Eligibility

Before enrolling for SNPs, a Medicare beneficiary must meet the following requirements:

  • Have Medicare Part A and Part B
  • Live in the SNP service area
  • Meet the eligibility requirements
It is important to note that Medicare beneficiaries with ESRD are usually not allowed to enroll in an MA plan, with certain exceptions. However, those who have ESRD may be eligible to enroll in SNP if available in their area.
Enrolling in a Medicare Advantage Special Needs Plan

Most people are first eligible for Medicare during their Initial Enrollment Period (IEP). This 7-month period starts three months before the beneficiary’s 65th birthday and ends three months later, including the birthday month. As for those that qualify for Medicare because of disability, their IEP starts three months before the 25th month that they receive Social Security disability benefits or Railroad Retirement Board disability benefits.

Medicare beneficiaries can also enroll in an SNP during the Annual Election Period from December 15 to January 7 every year. During this period, Medicare beneficiaries can enroll in an SNP for the first time, switch, and disenroll from their plan.

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Medicare Advantage Special Needs Plan Costs

Different Special Needs Plans offer different premium costs, and copays may also vary from plan to plan. Depending on the SNP, beneficiaries will usually have these costs to consider:

  • Medicare Part B premium
  • The monthly premium for SNP
  • The additional monthly premium for Medicare Part C (depending on the SNP)
  • Cost-sharing expenses such as deductibles, coinsurance, or copayments.
  • The extra monthly premium for additional benefits (depending on the SNP)

Call Senior Insurance Sales to speak with a licensed agent to review and compare an SNP that may be available in your area and is suitable for your needs.

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