What is a Special Needs Plan?

Medicare Special Needs Plans or SNPs are the most customized of Medicare Advantage plans. They are specifically designed to meet long term care needs for subscribers. Because the coverage is specifically tailored, care outside of the condition treatments is limited.

What do I need to know about a special needs plan?

Find the Special Needs Plan coverage that works for you

What Care is Covered Under an SNP?

When you enroll for a special needs plan, it will be designed around your treatment needs. If your condition requires dialysis and medication, then those should be covered by your plan. Additionally, because SNPs are a type of Medicare Advantage care, they will cover the same services.

Applicable Conditions for a Special Needs Plan

The eligibility situations covered by SNPs can be divided into three categories: chronic conditions, institutonal treatment, and dual eligibility. 

Chronic SNP coverage applies to the following:

  • Alcohol or chemical dependency
  • HIV/AIDS or other autoimmune diseases
  • Diabetes
  • Chronic heart failure
  • Dementia
  • Liver disease
  • End-Stage Renal disease
  • Debilitating blood disorders or disease
  • Chronic respiratory problems
  • Mental health conditions
  • Strokes and related recovery

Institutional SNPs are used for subscribers in nursing homes, inpatient psychiatric facilities, and for facilities treating intellectual disabilities.

Dual Eligibility SNP coverage applies to individuals with Medicare and Medicaid coverage.

Ask your insurance provider about which coverage option will fit your healthcare needs.

Do I Have to Have a Primary Care Physician?

Similary to PFFS and PPO plans, most Special Needs Plans do not require you to have a primary care physician, some plans may require you to declare one. Usually though, if a plan does not require a PCP, they will require you to have a care coordinator. A care coordinator ensures you are receiving all the care covered by your plan. Specifically, care coordinators help you get all doses of prescriptions, exercise, monitor blood sugar, and follow diets. If you have any questions about your SNP coverage, contact one of our insurance agents and find answers today!

Talk with your insurance provider to find the special needs plan that works for you

Let Us Help You Find The Right Plan

At Buffalo Health Advisors, we believe in providing solutions to individuals as they transition to Medicare plans. Not only can Medicare Advantage work to protect your health, choosing the right plan can go a long way toward protecting your wealth. This plan is critical if you are going to be living on a fixed income during your retirement years.

It will cost you nothing to learn more about the options available to you. Call or stop by our Nashville, TN office to discuss your Medicare plan options with one of our experienced agents.

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Medicare and insurance don’t need to be complicated. Talk to a Buffalo Health Insurance Benefits Advisor and let’s figure this out together. When you think Medicare, think Buffalo.

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