Understanding Medicare Special Needs Plans


Medicare Special Needs Plans come in many shapes and sizes, and not all are available everywhere

If you are enrolled in Medicare for your health care coverage – or you soon will be – it is important to have a good understanding of the different types of plans that are available. While Original Medicare (which is Medicare Part A and Part B), and Medicare Advantage are the most widely known options, there are some additional forms of coverage for some Medicare enrollees who are eligible. One such alternative is a Medicare Special Needs Plan.

Medicare Special Needs Plans (SNPs) are private Medicare Part C (Medicare Advantage) plans that serve certain qualifying individuals or groups of Medicare enrollees, such as those who:

  • Reside in certain institutions, such as skilled nursing facilities
  • Require home health care
  • Are eligible for coverage through both Medicare and Medicaid, and / or
  • Have certain disabling or chronic health conditions such as End Stage Rental Disease (ESRD), diabetes, or HIV

There are actually a few different versions of Medicare Special Needs Plan (SNP) available – and each of these plans can provide varying services and costs. For instance, if the SNP is a part of a Health Maintenance Organization (HMO), it will generally require that enrollees obtain their health care services from hospitals and doctors that are listed in the plan’s provider network. (This differs from Original Medicare in that Medicare Part A and B allow enrollees to see any doctor or provider).

It is important to note that unlike Medicare Part A and Part B – which offer the same set of benefits to all enrollees – Medicare Special Needs Plans can differ, based on what is offered by the insurance companies that provide them. In addition, an insurance carrier may offer more than just one Medicare Special Needs Plan in certain areas.

Also, private insurance companies that provide Medicare Special Needs Plans may opt to end their SNPs. Remember, these are actually special Medicare Advantage plans and, just like “regular” Medicare Advantage plans, insurance companies can offer them, and then take them away. Every year, they decide what plans they are going to offer in a certain county, and they (almost) constantly adjust the offerings and the benefits found within those plans. So, they may offer a SNP plan one year, and not, the next. You’ve got to stay on top of it every AEP and read your plan documents.

How Much Do Medicare Special Needs Plans (SNPs) Cost?

The cost of a Medicare Special Needs Plan will vary, based on the plan that you choose. Sometimes they come with a monthly premium, most of the time, they do not. Here’s a link to SNP plans found in Louisiana, just for an example. Sometimes, you have to have both Medicare and Medicaid (also known as a dual-SNP *pronounced SNIP) to qualify.

Typically, the premium that you pay will be the same or similar to the cost of having a Medicare Advantage (Medicare Part C) plan. If, however, you are eligible for Medicare and Medicaid, it is likely all of your Medicare Special Needs Plan costs will be covered for you, as well as all of your copays, coinsurance amounts, prescription drugs, etc.

Coordination of Care with a Medicare Special Needs Plan

Making sure that you are following your doctor’s orders and taking the right medication(s) at the proper time can be a key to getting – and remaining – in good health. For that reason, there are some Medicare Special Needs Plans that offer care coordination services.

For instance, if your Medicare SNP plan offers this service, then you may have access to a care coordinator who will assist you with getting – and taking – the right prescription drugs. They may also help you with choosing and eating healthy meals, and monitoring your blood pressure, blood sugar, and / or other key health related aspects.

If you are receiving both Medicare and Medicaid benefits, then a care coordinator could help you to coordinate your benefits with each of these entities, as well as provide additional assistance such as accessing community resources that are available to you.

The Benefits of Being Enrolled in a Medicare Special Needs Plan

There are several benefits for being enrolled in a Medicare Special Needs Plan. For example, because SNPs require that prescription drugs also be covered, there is no need to obtain additional coverage for this (such as a stand-alone Medicare Part D prescription drug plan).

In addition, there are some Medicare Special Needs Plans that provide specialized services for their enrollees, such as regular access to nurses and / or care managers. And, for those who are dual eligibles (i.e., those who are enrolled in both Medicare and Medicaid), a Special Needs Plan may even offer coordination of these coverages for you.

Because Medicare Special Needs Plans are only open to those who meet certain criteria, it is possible that you may not always be qualified for an SNP plan. With that in mind, if you do end up losing your eligibility for an SNP plan, then you will have a Medicare Special Enrollment Period during which you can make another health care coverage choice.

This Special Enrollment Period time frame will begin when your Medicare Special Needs Plan notifies you that you are no longer eligible for the SNP plan, and it will continue throughout a given grace period. Given that, it is essential that you carefully review all of your new coverage options in order to ensure that you will continue receiving the benefits that best fit your particular needs.

For additional information regarding Medicare Special Needs Plans, you can visit Medicare’s website by going to www.Medicare.gov, and then search for Medicare Special Needs Plans. You can also contact Medicare toll-free by phone at (800) MEDICARE.

Got a Medicare question? We love questions. Contact us.
Author Bio: Ben started Prepare for Medicare in 2014 to help people help people get objective answers to questions about Medicare. He’s held leadership roles at numerous Fortune 500 Medicare health insurers in product development, sales, marketing and strategy for over 20 years.


How Medicare Special Needs Plans (SNPs) Work. https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/how-medicare-special-needs-plans-snps-work