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Overview of Medicare Advantage Special Needs Plan

Overview of Medicare Advantage Special Needs Plan


Medicare Special Needs Plans (SNPs) are offered by private companies to provide Medicare Part C & D to certain groups of people qualified for Medicare. The companies offering these plans must be approved by Medicare. All Medicare Special Needs Plans must also include Prescription Drug (Medicare Part D) coverage.

Special Need Plans are usually health maintenance organization (HMOs) or preferred provider organizations (PPOs). Enrollment in Special Needs Plans is limited to people with qualifying diseases or circumstances.

A Special Needs Plan covers virtually all the health care needs of its members. The idea is that these plans can tailor the benefits, health care provider choices, and list of prescription drugs to fit the special needs of people with a specific, serious disease or other circumstances.

According to Your Guide to Medicare Special Needs Programs , there are three types of Special Needs Plans.

  1. Chronic Disease Special Needs Plans1

    These plans may be available to qualified individuals with serious and/or disabling health conditions. The list of diseases that may make you eligible for one of these plans includes:

    • Chronic alcohol and other drug dependence
    • Autoimmune disorders
    • Cancer (excluding pre-cancer conditions)
    • Cardiovascular disorders
    • Chronic heart failure
    • Dementia
    • Diabetes mellitus
    • End-stage liver disease
    • End-Stage Renal Disease (ESRD) requiring any mode of dialysis
    • Severe hematologic disorders
    • HIV/AIDS
    • Chronic lung disorders
    • Chronic and disabling mental health conditions
    • Neurologic disorders
    • Stroke
  2. Institutional Special Needs Plans
    • These plans may be available to eligible individuals who live in a nursing home or need a nurse to care for them in their home.
  3. Dual Eligible Special Needs Plans
    • These plans may be available to people who are eligible for both Medicare and Medicaid.

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