Special needs plan is a type of Medicare advantage plan like HMO and PPO, that limits memberships to people who have a specific disease. Medicare SNPs tailor their provider choices, drug formularies, and their benefits to best meet the specific needs of the groups they serve.
Example:
Dual Special Needs Plan: A Medicare Advantage Plan that coexists with Medicaid.
Eligibility for Dual Special Needs Plan?
- Must have Part A & B.
- Qualified for state assistance such Medicaid.
- Offered in the plans area (County base)
Chronic Special Needs Plan: Is a unique plan that designed for a specific chronic condition such as:
- Diabetes
- Dementia
- Heart condition
- ERSD (End-stage renal disease)
MA carriers offer C-SNP’s Plan in select areas; however, some plans are only specific to a certain chronic illness.
Who can enroll for Dual/Chronic Special Needs Plan?
- Must have Part A & B.
- Medicaid eligibility.
- Qualified chronic conditions.
A list of qualifying chronic illness can be found at cms.gov for further information.
