Special Needs Plans are a type of Medicare Advantage plan that limits enrollment to Medicare beneficiaries who meet certain eligibility criteria. These plans cater their benefits to serve the unique needs of its members.
There are three types of Special Needs Plans (SNPs) available:Chronic-Condition Special Needs Plans (C-SNP): 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.
Institutional Special Needs Plans (I-SNP): These plans serve those living in an institution (such as a nursing home) or who need nursing care at home.
Dual-Eligible Special Needs Plans (D-SNP): These plans serve people who have both Medicare and Medicaid benefits (also known as “dual eligibles”).
If you fall into any of these categories, you may have unique health-care needs that a Special Needs Plan may be better equipped to address. For example, some Special Needs Plans offer a larger network of providers that specialize in treating your condition or have formularies that are tailored to cover the prescription drugs typically prescribed for your particular illness.
Some Special Needs Plans include care-coordination services to help you better understand your condition and stick to your doctor’s treatment regimen. Or you might have access to wellness programs to help with a special diet or other lifestyle activities that can help improve your condition.
Chronic-Condition Special Needs Plans may include provider networks with physicians and hospitals that specialize in treating the specific condition of its members, or they may have formularies that are tailored to include the prescription drugs that treat that illness.
If you’re enrolled in a Special Needs Plan for dual eligibles, there may be certain social services available to help you coordinate your Medicare and Medicaid benefits.
It’s important to note that you still get all the coverage that is otherwise included with Original Medicare, Part A and Part B, and Medicare Part D.
The Special Needs Plan simply offers extra coverage to help you better manage your particular situation, whether that’s living in a nursing home; coordinating your Medicare and Medicaid benefits; or treating a serious chronic illness.
One key difference between a Special Needs Plan and other types of Medicare Advantage plans is that all Special Needs Plans must cover prescription drugs. In contrast, other Medicare Advantage plans (for example, HMOs and PPOs) may or may not include prescription drug coverage, depending on the specific plan.
Medicare Advantage Special Needs Plans costs
Depending on the Special Needs Plan, you will typically have the following costs:
Medicare Part B premium
Monthly premium for your Special Needs Plan
Extra monthly premium for prescription drug coverage (if your SNP requires it).
Extra monthly premium for additional benefits (if your SNP requires it).
Cost-sharing expenses, such as copayments, coinsurance, or deductible.