Medicare Special Needs Plans

A Special Needs Plan (SNP) is a type of Medicare Advantage coordinated care plan.

SNPs tailor the benefits, provider choices and drug formularies they offer to best serve the specific needs of beneficiaries.

For example, a private health insurance company might offer a SNP for people with heart disease. The plan benefits could include additional coverage for common medications used to treat heart disease as well as a network of doctors who specialize in cardiovascular health.

Like any Medicare Advantage plan, SNPs are required to provide the same basic benefits, rights and coverage as Original Medicare. But these plans may operate under different rules, network restrictions and costs.

All SNPs must provide Medicare prescription drug coverage. Some plans may offer additional benefits, such as vision, dental and hearing care.

Typically, you are required to seek care and services from providers within your SNP network. In most cases, SNPs require you to have a primary care doctor.

Different special needs plans are available depending on where you live. They are not available everywhere in the U.S.

A new Medicare beneficiary can join a SNP any time during the initial enrollment period.

Once enrolled, you can switch plans only between Oct. 15 and Dec. 7 each year, though a few exceptions to this rule exist.

Enrollment in a Medicare Advantage SNP is limited to specific groups.

This can include people living in institutions, people who are dual eligible for Medicare and Medicaid, or people with certain chronic conditions.

You can only remain enrolled in a SNP if you meet the plan’s eligibility requirements.

According to the U.S. Centers for Medicare & Medicaid Services, there are 15 conditions that qualify for a Chronic Condition Special Needs Plan, or C-SNP.

If you have Medicaid, you will not pay Medicare deductibles and copays from providers in your Dual Eligible SNP network.

If you don’t have Medicaid, your exact costs will vary depending on the plan you select.