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Is a Medicare Special Needs Plan Right for You?

Joanne BentelerNovember 7, 2023

Is a Medicare Special Needs Plan Right for You?

Many beneficiaries don’t know that Medicare offers Special Needs Plans (SNPs) for people with specific diseases, certain healthcare needs, or who are dually eligible for Medicaid. SNPs are health plans that provide care coordination services and tailor their benefits, provider networks, and drug lists (called formularies), to meet the specific needs of the people they serve. All SNPs use a care coordinator to help you stay healthy and develop a care plan with you.

What Special Needs Plans are available?

Each year, different types of SNPs are offered in different parts of the country, so not all SNPs are available in all areas. There are 3 types of special needs plans:

Chronic Condition SNP (C-SNP). For beneficiaries with specific chronic conditions, such as cancer, dementia, diabetes, HIV/AIDS, stroke, End-Stage Renal Disease (ESRD), and certain neurologic disorders

Dual Eligible SNP (D-SNP). For beneficiaries enrolled in Medicare and Medicaid (dually eligible individuals)

Institutional SNP (I-SNP). For beneficiaries who, for 90 days or longer, have or will need services provided in an institution, such as a skilled nursing home, long-term care skilled nursing facility, intermediate care facility, or assisted living facility

⊕ Read our blog, Medicare Special Needs Plans Offer Targeted Benefits, to learn more about the 3 types of SNPs.

Who can join a Special Needs Plan?

You can join an SNP if you:

  • Have both Medicare Part A and Medicare Part B
  • Live in the plan’s service area
  • Meet the eligibility requirements for one of the 3 types of SNPs:
    • You must apply and prove that you meet the SNP’s eligibility criteria
    • The SNP will require periodic proof that you continue to meet these criteria

Get more information on SNP eligibility requirements.

What if my condition changes and I am no longer eligible for my SNP?

If the condition served by the special needs plan changes and you are no longer eligible, you may qualify for a Medicare Special Enrollment Period to join another plan.

Learn more or enroll in a Medicare SNP

American Exchange’s licensed Medicare enrollment experts are available to help you better understand Medicare special needs plans. We can help you enroll in a special needs plan or in any Medicare health plan available in your area. And we are a phone call away all year long to explain how your plan works and answer your insurance-related questions. Contact us today. 

1.888.995.1674          View our Medicare webpage

Schedule an Appointment

Our Medicare experts are available to help you:

Monday through Friday from 8:00 a.m. to 5:00 p.m.

Extended hours during open enrollment (November 1, 2023 – January 15, 2024):

Saturdays from 8:00 a.m. – 5:00 pm Eastern Time 

We are closed on the following holidays:
Thanksgiving: November 24-25
Christmas: December 23-25
New Year’s Day: January 1

Free Medicare Resources

We publish a Medicare blog on the 4th Tuesday of every month, and more frequently during Medicare’s Annual Enrollment Period. Be sure to read our Medicare blog posts or flyers to better understand your coverage.

Medicare Disclaimer: We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.

American Exchange is a licensed health insurance broker. Robert Huffaker, NPN 13568432

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