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

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

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.

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