Special Situations Call for Special Needs Plans

We all hope to live long and healthy lives, well into our retirement years. But sometimes life has other plans for us. In the event that you’re diagnosed with a condition that requires specialized medical care, will your Medicare plan really provide for all of your needs? In many cases, the answer is “not really”. That’s why Medicare Special Needs Plans (SNPs) were created.

What is a Special Needs Plan? SNPs were created to provide for the specialized care required by patients with certain serious health conditions. The plan’s network of providers, prescription formulary, and other benefits are centered around the patient’s condition. Your SNP might also include a care coordinator whose job is to assist you or your loved ones in managing your condition. Their job revolves around following your physician’s particular orders, coordinating community resources, and obtaining the right prescriptions in a timely manner.

How do you qualify for a Special Needs Plan? To qualify for a SNP, you must be a Medicare patient and diagnosed with one of the following conditions which necessitate specialized care:

  • Autoimmune disorders
  • Alzheimer’s or dementia
  • Cancer
  • Cardiovascular disease, stroke, or chronic heart failure
  • Diabetes
  • End-stage renal disease, requiring dialysis
  • Hematologic disorders
  • HIV or AIDS
  • Chronic lung disorders (such as COPD)
  • Chronic or disabling mental illness
  • Neurologic conditions

Not all plans are available in all geographic areas, and moving could affect your eligibility.

What other types of SNPs are available? In addition to the conditions listed above, those who are expected to be institutionalized for 90 days or longer might be eligible for an Institutional Special Needs Plan, which helps you coordinate care when you’re no longer able to live independently.

Dual-Eligible Special Needs Plans are available to those who qualify for both Medicare and Medicaid (Medi-Cal in California). These plans can assist with the following:

  • Telemedicine services
  • Transportation to appointments and pharmacies
  • Dental, hearing, and vision benefits
  • Gym memberships
  • Quarterly benefits for over-the-counter products

When can I enroll in a SNP? You can enroll in a SNP when you become eligible for one, meaning you don’t have to wait for the Annual Election Period or Open Enrollment.

For more information on Special Needs Plans, consult with one of our insurance brokers who specialize in Medicare plans. We can help you idenitify the plans available in your area, and sort through your options to decide what type of plan works best for you.

Posted by PGIA
2 years ago / May 4, 2022

Filed Under: Medicare Info