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What is a Medicare Special Needs Plan?


Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage plan that provides coordinated care to beneficiaries with specific needs or situations. These plans limit their membership to beneficiaries who have specific illnesses, chronic conditions, or special circumstances..

The SNP plans must include all of the same services as Original Medicare Parts A and B. However, Special Needs Plans tailor their plan benefits, network, and drug formulary to meet the needs of individuals who have these specific health conditions or circumstances. For example, all Special Needs Plans include a built-in Part D drug plan.

Who can sign up for an SNP plan?

To qualify for enrollment into a Special Needs Plan, you must

live in the plan’s service area and

be enrolled in both Medicare Parts A and B.

A plan must limit membership to these groups:

people who live in certain institutions (like a nursing home) or who require nursing care at home, or

people who are eligible for both Medicare and Medicaid, or

people who have specific chronic or disabling conditions (like diabetes, End-Stage Renal Disease (ESRD), HIV/AIDS, chronic heart failure, or dementia)

When can you sign up for an SNP plan?

You can enroll in an SNP Medicare Advantage plan during your Initial Enrollment Period for Medicare or during any Medicare Annual Enrollment Period. Some people may also qualify for Special Enrollment Periods during the year in certain situations. These include:

Moving outside of your current plan’s service area

Qualifying for Medicaid

Moving into, living in, or moving out of an institution

Being diagnosed with a severe or chronic condition that qualifies you for a Chronic condition SNP

If you lose your eligibility for an SNP, you will have a grace period within which you can leave the plan and join another plan or return to Original Medicare.

What do you pay in a Medicare SNP?

In general, you will continue to pay your Part B premium to Social Security the entire time that you are enrolled in the plan unless you are covered by Medicaid. If you have Medicare and Medicaid, most of the costs of joining a Medicare SNP will be covered for you.

If you don't have both Medicare and Medicaid (or get other help from your state paying your Medicare premiums), your exact costs will vary depending on the plan you choose. You will pay any monthly premium that the plan itself charges for the SNP. You will also pay the regular cost-sharing expenses, such as deductibles, copays, and coinsurance.

SNP plans are not suitable for all Medicare-eligible members. There is a lot to be considered before joining an SNP plan. WE ARE HERE TO HELP!


As Independent Insurance Brokers, we are appointed by many of the major insurance carriers that offer Medicare advantage policies including the SNP plans in Virginia and West Virginia. We can help you find the best policy for your individual situation. Contact us today at (540) 662-4432 to speak with one of our Insurance agents or visit our website medicaretrustedagents.com to obtain more information.

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