Our Services Are Always 100% Free

Speak with a licensed agent: 702-840-1111

Our Services Are Always 100% Free

Speak with a licensed agent: 702-840-1111

Special Needs Plans

Medicare Special Needs Plans (SNPs) are type of Medicare Advantage plan that provides coordinated care to beneficiaries with specific needs or situation. Like all Advantage plans, Special Needs Plans will have a network, usually either an HMO or a PPO.

These SNPs limit their membership to beneficiaries who have specific illnesses, chronic conditions, or circumstances. The plans must include all of the same services as Original Medicare Parts A and B.

However, Special Needs Plans tailor their plan benefits, network and drug formulary to meet the needs of individuals who have these specific health conditions. All Special Needs Plan include a built-in Part D drug plan.

These plans serve beneficiaries with certain severe or disabling chronic conditions, such as cancer, chronic health failure, or HIV/AIDS. Chronic-Condition Special Needs Plans may target a single chronic condition or more than one condition. For example, the SNP might offer provide access to a group of providers who specialize in treating these specific illnesses.

These providers work together to coordinate your care. The plan will often assign a care coordinator or case manager to assist you with keeping healthy, managing your health condition and following your provider’s orders. He or she might also help you with accessing community resources or getting the right prescriptions in a timely manner.

The drug formulary that is built into the plan is also likely to offer a vigorous list of drugs that treat this particular health condition.

You must have one or more of health conditions listed below in order to qualify or deemed Chronic Condition:

  • Autoimmune disorders
  • Cancer
  • Cardiovascular disease, stroke, or chronic heart failure
  • Alzheimer’s or Dementia
  • Diabetes
  • ESRD requiring dialysis
  • Hematologic disorders
  • HIV or AIDS
  • Chronic lung disorders (like COPD)
  • Chronic or disabling mental illness
  • Neurologic conditions

To join a Chronic Illness Special needs Plan, your doctor will have to complete a chronic condition verification form at the time of your enrollment. We will provide you with the form and your doctor can complete this form and return it to verify your eligibility.

Insurance companies get to choose where they will offer certain plan designs, so you may or may not be able to find a SNP in your area that specializes in the condition that you have. Check with us to see what is offered in your area..

If you live in an institution, such as an assisted living center, nursing home or memory care center) may qualify for an Institutional Special Needs Plan (I-SNP).

These plans focus on dealing with the provision of coordinated care to someone who is no longer living independently. The beneficiary must be expected to live in the institution for at least 90 days. These plans are similar to chronic special needs plan.

Dual Eligible Special Needs Plans (D-SNPs) enroll individuals who are entitled to both Medicare (Government)  and medical assistance from a state plan under Medicaid. Some Medicare beneficiaries also qualify for Medicaid. Medicaid is a federal and state health insurance program for people with low incomes.

When you qualify for both, you can keep your Original Medicare and have Medicaid function as your secondary coverage, or you can enroll in a Dual Eligible Special Needs Plan.

The costs to join a Medicare DNSP will mostly be covered for you. You can expect to spend little to nothing on deductibles, co-pays, and coinsurance for Part A and B services provided by the plan.  Many plans have a $0 premium because Medicaid pays any plan premium for you.

Dual Special Needs Plans often also offer rich ancillary benefits. These might include:

  • Quarterly benefits for over the counter products
  • Telemedicine services
  • Transportation to and from doctor appointments or trips to the pharmacy
  • Routine dental, vision and hearing benefits
  • Gym memberships

We can verify your eligibility for Medicaid before you can enroll into the Dual Special Needs Plan.

The first step to setting up affordable health insurance is knowledge. Let our experts help you learn your basic benefits. Call Us our help is always 100% free.

In order to qualify and enroll into a Special Needs Plan, you must live in the plan’s service area and be enrolled in both Medicare Part’s A and B. You will continue to pay your Part B premium to Social Security the entire time that you are enrolled in the plan (unless this is covered for you by Medicaid.)

You will also pay any monthly premium that the plan itself charges for the SNP. Finally you will pay the regular cost-sharing expenses, such as deductibles, co-pays, and coinsurance. These amounts can be found in the plan’s Summary of Benefits, which you should review before joining the plan.

You can enroll in a Medicare Advantage SNP during your Initial Enrollment Period for Medicare or during any Medicare Fall Annual Election Period. Some people may also qualify for Special Enrollment Periods during the year in certain situations. These include:

  • Moving outside of your current plan’s service area
  • Qualifying for Medicaid
  • Moving into, living in, or moving out of an institution
  • Being diagnosed with a severe or chronic condition that qualifies you for a Chronic condition SNP


IMPORTANT: If you lose your eligibility for a SNP, you will have a grace period within which you can leave the plan and join another plan or return to Original Medicare.