What Is a Medicare Special Needs Plan and Who Qualifies?

Seniors suffering with a debilitating chronic health condition may be eligible to join a Medicare approved Special Needs Plan (SNP). An SNP provides additional benefits above and beyond Original Medicare, offering seniors with special care requirements the treatment and services they need. What is a Special Needs Plan and who qualifies? The following information can help you understand eligibility requirements and plan details to determine if a Medicare Special Needs Plan is the right choice for you.

What Is a Medicare Special Needs Plan and How Much Does It Cost? 

Treatment of certain chronic health conditions such as cancer or dementia may require additional services above and beyond that which Medicare provides. For many seniors, extra cost associated with treatment is a burden and Special Needs Plans address these concerns. Most benefits provided by an SNP are paid in full for recipients who are enrolled in both Medicare and Medicaid. However, for seniors who do not qualify for Medicaid, participating in an SNP costs about the same as enrollment in a typical Medicare Advantage plan. 

Eligibility Requirements 

To be eligible to join a Medicare Special Needs Plan, you must be enrolled in Medicare Part A and Part B, reside in the plan’s service area and meet specific medical requirements. Seniors with a disabling chronic condition or who live in a nursing home, require in home care or currently receive both Medicare and Medicaid benefits may qualify. SNPs may not be available in all states as insurance companies providing benefits decide which counties will offer coverage.

What Qualifies as a Chronic Condition? 

Many seniors face chronic health conditions with age. However, to qualify for a Special Needs Plan, seniors must have one or more of the following chronic conditions:

Alcohol or drug dependence

Hematologic disorder

Autoimmune disorder

HIV/Aids

Cancer

Chronic lung disorder

Cardiovascular disorder

Disabling mental health condition

Chronic heart failure

Neurologic disorder

Dementia

Stroke

Diabetes

End stage liver disease

Is a Medicare Special Needs Plan Right For You? 

Navigating Medicare and available benefits can be challenging, and it’s always a good strategy to learn as much as you can about all programs that may be able to help. If you are suffering with a chronic condition, an SNP may be the right choice. With an increased network of providers who specialize in treating your condition and additional benefits, getting the care you need and deserve may be easier than you realize.

https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/special-needs-plans.html

https://www.medicare.gov/Pubs/pdf/11302.pdf

MUC14-2016-BCBS