Can you explain Special Needs Plans in Medicare?

Question

Steven Bleicher · Accepted Answer

Sure. If you are already qualified for Medicaid and are about to enroll with Medicare, you're going to qualify for a "SNP" or Special Needs Plan. This means that you are not going to pay for ANYTHING at all since your status (financially speaking) has been approved. Not every insurance firm offers a SNP plan. You will have to do a little searching but it should be fairly easy to do. By the way, if you've been granted Medicaid status by either a State or Federal agency and two years have elapsed, no matter what your age, you can enroll with Medicare! There are clients who are in their 50's who were approved for Medicaid and then 24 months later, they were able to only enroll into an Advantage plan with drug coverage. But, when you are Medicare-eligible at age 65, you can transition to a Medicare Supplement and a Part D(rug) plan, each with a monthly premium, if that is your preference.

Answered by Steven Bleicher on April 11, 2025

Broker Licensed in AZ

Answered by Steven Bleicher Medicare Insurance Agent

William Gray · Answer

There are people who have special circumstances that CMS has determined qualify for extra help and benefits. 

There are several different categories. 

Dual Special Needs - Medicare / Medicaid eligible. 
Chronic Special Needs - Those with listed health conditions
SNP - facility plasn - Those who are confined to a facility. 

each case is different it is best to talk with a professional

Steven Whetstine · Answer

In Medicare, there are three major types of Special Needs Plans with Medicare.  They are specific to Medicare Advantage plans.  It is important to review which plans are available in your geographic area.

Institutional Special Needs Plans are very specific to a nursing home level of care or in a nursing or assisted living setting.  

Dual Special Needs plans are specific to Medicare Beneficiaries who have both Medicare and Medicaid.  

Chronic Special Needs Plans are for people with chronic or severe conditions.  This can include individuals with chronic heart conditions, cardiovascular disease, diabetes, autoimmune diseases, and certain neurological diseases.  These plans offer benefits specific to the chronic and severe conditions and offer an enhanced coordination of care for Medicare Beneficiaries who have this plan.

Christy Jones · Answer

Special needs plans are Medicare Advantage plans. They are designed for people who have specific health conditions or needs. There are special needs plans specifically designed for people who have Medicaid. There are also chronic special needs plans designed for people who have specific chronic conditions..

Answered by Christy Jones on June 8, 2025

Broker Licensed in ID, AL, AR & 20 other states

Answered by Christy Jones Medicare Insurance Agent

Yasmine Lopez · Answer

Special Needs Plans are a type of Medicare Advantage plan designed for people with specific circumstances — and they can offer extra benefits and lower costs if you qualify.

There are two main types:

Dual Eligible SNP (D-SNP)
These plans are for people who qualify for both Medicare and Medicaid.
Medicaid programs vary by state (they might be called something like Utah Medicaid, Medi-Cal in California, or TennCare in Tennessee), but they’re all designed to help individuals living at or near the federal poverty level.
D-SNPs often include added support like help with transportation, dental and vision, and reduced prescription costs.

Chronic Condition SNP (C-SNP)
These plans are built for people with certain chronic medical conditions — like diabetes, heart disease, or COPD. Some areas may offer plans for other conditions too.
To qualify, your doctor will need to confirm your diagnosis.
These plans often include extra care coordination and benefits tailored to managing that condition effectively.

Bottom line: If you qualify for a Special Needs Plan, you may get better coverage and care designed around your specific needs — and I can help you see what’s available in your zip code.

Justin Lucas · Answer

Special Needs plans are for people that have certain chronic health conditions or specific needs. These plans are to enhance the healthcare coordination.

Michael Pyers · Answer

They are for people with certain chronic conditions.  Dual Special needs plans are for people with Medicare and Medicaid.

Steve Houchens · Answer

There are a few different types of Special Needs Plans.First a Dual Eligible Special Needs Plan or D-SNP, is for people that are Medicare & Medicaid eligible. Second there are Chronic Special Needs Plans, C-SNP which are for people with a chronic disease or illness such as diabetes, chronic kidney disease, COPD and other specific illnesses.

Answered by Steve Houchens on April 10, 2025

Agent Licensed in KY & TN

Answered by Steve Houchens Medicare Insurance Agent

DeeDee Whitlock · Answer

These are Medicare Advantage Plans that have a network of doctors that help people with certain diagnosis that cater to helping you with those illnesses

Michael Yost · Answer

Special Needs Plans are designed to help cover specific areas or needs for people. For example, there is a special needs plan called a dual plan. This is when someone has both Medicare + Medicare. There is also a special needs plan called a Chronic plan. This kind of plan is more for those that are diabetic or have a cardiovascular disease. These special needs plans sometimes offers more benefits than a normal plan.

Answered by Michael Yost on June 11, 2025

Broker Licensed in OH, AL, AZ & 27 other states

Answered by Michael Yost Medicare Insurance Agent

Christie Bondos · Answer

Dual Special Needs Plans are for those individuals who qualify for Medicaid with the Medicare Savings Program and have different levels of Low Income Subsidy Needs. In Ct the beneficiary will receive a Gray Connect Card which has their Client ID. This works with the Dual Special Needs Plans to cover their medical needs and offer zero copayments and a wider network of Medicare/Medicaid Providers for the insured. They also have enhanced Ancillary benefits for Dental, Vision, Hearing, and Value Added Benefits. Well seasoned agents work with you to see if you qualify by applying to DSS and then which plan is the best fit according to your dr's and medications..

Answered by Christie Bondos on May 26, 2025

Broker Licensed in CT

Answered by Christie Bondos Medicare Insurance Agent

Steve Brauer · Answer

Special Needs Plans for Medicare usually serve people with Heart, Liver, or Kidney issues and, in some areas of the country, lung issues. Certain Medicare Advantage Plans are designed to specifically address those medical issues with a more focused problem-solving approach.

Answered by Steve Brauer on April 13, 2025

Broker Licensed in AZ & CA

Answered by Steve Brauer Medicare Insurance Agent

Andrew Kramer · Answer

SNP's (Special Needs Plans) vary according to the county. There are 2 types:
1. D-SNP - Dual plans for those with both Medicare & Medicaid. The advantage of joining a dual plan is being in a large Dr network of that Advantage plan, rather than trying to find Dr's who accept both Medicare and Medicaid. Also most dual Advantage plans offer more benefits, i.e. a food spending card, dental, vision, etc.
2. C-SNP - Chronic plans for those typically with diabetes, heart disease and pulmonary illness, and sometimes kidney failure.
3. I-SNP - Institutional Special Needs Plans are for individuals who need a long-term stay in a medical institution, such as a skilled nursing facility or rehabilitation center.
SNP's can be joined any time during the year, if you are newly qualified for one.

Todd Bostic · Answer

There are 2 types of Special Needs Plans, or SNPS for short there is the Critical Care Special Needs Plan, or CSNP, and there is the Dual Special Needs Plan, or DSNP. 

The CSNP is typically for people that have a critical illness like diabetes, or heart problems or on dialysis. Not all people with those conditions qualify and some plans have other conditions that allow people to qualify. In some cases it comes with a small monthly food allowance and specialist are usually less than typical MAPD plans. 

The DSNP is for people that have both Medicare and Medicaid. DSNP plans have many benefits including a food card in most cases. Depending on the level of Medicaid a person is on, drugs, doctors, hospital visits, and many other benefits can be quite lucrative. However even if you have a low level of Medicaid, you can get a monthly food card.

Sonya Chandler · Answer

Special Needs Plans are for people with certain chronic conditions.  They are also for people who have Medicare and Medicaid.

Robert Baez · Answer

A SNP provides benefits and services to people with specific severe and 
chronic diseases, certain health care needs, or who also have Medicaid 
coverage. SNPs include care coordination services and tailor their benefits, 
provider choices, and list of drugs (formularies) to best meet the specific 
needs of the groups they serve.

Gus Kinnie · Answer

Special Needs Plans (SNPs) are a type of Medicare Advantage plan. Think of them as Medicare plans made for people with specific health care needs.

Ed Taylor · Answer

This is from the Medicare.gov website:
What's an SNP?
A Special Needs Plan (SNP) provides benefits and services to people with specific severe and chronic diseases, certain health care needs, or who also have Medicaid. SNPs include care coordination services and tailor their benefits, provider choices, and list of covered drugs (formularies) to best meet the specific needs of the groups they serve.

SNPs are either HMO or PPO plan types and cover the same Medicare Part A and Part B benefits that all Medicare Advantage Plans cover. However, SNPs might also cover extra services for the special groups they serve. For example, if you have a severe condition, like cancer or congestive heart failure, and you need a hospital stay, an SNP may cover extra days in the hospital. You can only stay enrolled in an SNP if you continue to meet the special conditions of the plan.

What are the eligibility requirements for SNPs?

Dual Eligible SNP (D-SNP) – You’re eligible for both Medicare and Medicaid. Some D-SNPs may provide Medicaid services in addition to Medicare services. D-SNPs contract with your state Medicaid program to help coordinate your Medicare and Medicaid benefits, depending on the state and your eligibility.
Chronic Condition SNP (C-SNP) – You have one or more of these severe or disabling chronic conditions:
Chronic alcohol and other dependence
Certain autoimmune disorders
Cancer (excluding pre-cancer conditions)
Certain cardiovascular disorders
Chronic heart failure
Dementia
Diabetes mellitus
End-stage liver disease
End-Stage Renal Disease (ESRD) requiring dialysis (any mode of dialysis)
Certain severe hematologic disorders
HIV/AIDS
Certain chronic lung disorders
Certain chronic and disabling mental health conditions
Certain neurologic disorders
Stroke
Institutional SNP (I-SNP) – You live in the community but need the level of care a facility offers, or you live (or are expected to live) for at least 90 days straight in a facility like a:
Nursing home
Intermediate