The plan network, benefits, and drug formulary are all centered on the patient’s condition in order to provide the appropriate support. Many SNP plans also assign care coordinators to assist patients in managing their condition, following physician orders, accessing community resources, and obtaining timely prescriptions.

To qualify for a Special Needs Plan on the basis of chronic illness, the Medicare beneficiary must be diagnosed with one or more of the following conditions:

✅ 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

Chronic illness SNPs vary by geographical area, with insurance companies deciding where certain plan designs are offered. Therefore, not all patients with chronic conditions will be able to locate a plan designed around their needs in their area. Additionally, moving to a new home in a different coverage area will impact eligibility. A licensed insurance professional can offer more assistance in locating these plans.

Some other types of Special Needs Plans include Institutional SNPs and Dual-Eligible SNPs. A patient who is expected to be institutionalized for 90 days or longer might be eligible for an Institutional SNP, designed to coordinate the care of a patient no longer living independently.

Dual-Eligible Special Needs Plans, or DSNPs, are available to individuals who qualify for both Medicare and Medicaid. In many cases Medicaid will pay the premiums, along with a significant portion of co-pays and deductibles.

The benefits of a DSNP include the following:

✅ Telemedicine services

✅ Transportation to appointments and pharmacies

✅ Dental, hearing, and vision benefits

✅ Gym memberships

✅ Quarterly benefits for over-the-counter products

Enrollment in any SNP is based upon geographical area, and the individual must maintain enrollment in Original Medicare. Part B premiums will still be paid to Social Security, unless Medicaid eligibility covers those. The SNP will charge a premium separately, and the patient is also responsible for co-pays and deductibles as determined by the plan.

Those who become eligible for a SNP at any point during the year are eligible for a Special Enrollment Period, during which they can select a SNP.