Call (206) 219-5306 to speak with a licensed insurance agent.

Call (206) 219-5306 to speak with a licensed insurance agent.

What is a Medicare Special Needs Plan and Who Qualifies for One?

Posted by Nate Root, March 22, 2023

Medicare plans are plentiful, and we are always happy to help you shop for a plan that meets your precise needs. But most plans are organized similar to other network-based health insurance plans, based upon a network of general providers and facilities. For those with very unique medical needs, it’s possible that neither Original Medicare nor a Medicare Advantage plan will make a good fit. In those cases, a Special Needs Plan might be a better option.

Special Needs Plans are Medicare Advantage plans that are only open to people with certain circumstances or diagnoses. Your provider network, benefits, and even your drug formulary will be tailored specifically to your needs, helping you to better manage your care.

Who is eligible to enroll in a Special Needs Plan?

  • People who live in nursing homes or require nursing care at home.
  • Those who are eligible for both Medicare and Medicaid
  • Patients with specific conditions (like diabetes, end-stage renal disease, chronic heart failure, HIV/AIDS, or dementia, for example)
  • Certain groups of related conditions might qualify you for a SNP.

Why choose a Special Needs Plan?

On a Special Needs Plan, you will have access to a care coordinator, who can help you make choices about your medical care. All SNPs must provide drug coverage, and the formulary is more likely to benefit you than a standard Part D plan.

You might require a referral to see a specialist on some SNPs, while others allow you to make appointments with the specialists of your choice.

For more information on a Special Needs Plan that suits your specific needs, call us to speak with one of our licensed agents. We can help you determine if you’re eligible for this type of Medicare plan, and if the plan’s structure and benefits are right for you.

Need more information?

Contact us online to learn more

Contact Us

Close Accessibility Tools
Accessibility Controls Reset
Content Adjustments
Font Size

Default

Line Height

Default

Content Scaling

Default

Highlight Titles
Highlight Links
Highlight Forms
Align Left
Align Center
Align Right
Focus Mode
Color Adjustments
Desaturate
Monochrome
Contrast

Default

Saturation

Default

Accessibility Statement

Despite our attempts to make this website accessible for everyone, there may still be some pages or sections that are not completely accessible, are in the process of becoming accessible, or do not have a suitable technological solution to make them accessible. Nevertheless, we are always striving to enhance our accessibility by adding, updating, improving its options and features, and incorporating new technologies.

We want to provide our users with the best experience possible, so we strive to support as many browsers and assistive technologies as possible.

If you wish to contact this website's owner, please use the contact form on the website.

Our User Interface Adjustment Options

Font adjustments - With this tool, users can modify font size, style, letter spacing, and line height for improved alignment and readability.

Color adjustments - Users can customize their color contrast profiles to light, dark, desaturated, and monochrome.

Content highlighting - Users can prioritize key elements such as links, forms, and titles.

Content focus - Users can enable focus mode to highlight the current page information based on their mouse movement.

Close