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Chronic Special Needs Plans

Special Needs Plans of all types have the same general guidelines. Chronic Special Needs Plans fit within this category of Medicare Advantage Plans.

A Chronic Special Needs Plan:

  • May or may not allow you to get treatment out-of-network. This varies based the specific policy available to you
  • Requires you to choose a primary care doctor
  • Requires you to get a referral from your primary care doctor in order to see a specialist

These plans also include prescription drug coverage

What are some defining features of the Chronic Special Needs Plans?

Chronic Special Needs Plans are geared toward those with severe medical conditions. Someone joining this program will have a network of healthcare providers who have extensive training in treating his or her condition.

Medical conditions that qualify one for this policy include (but are not limited to):

  • Stroke
  • COPD
  • Dementia
  • Chronic Heart Failure
  • Cancer

Influential Factors

The following may be deciding factors in whether a person joins:

  • With this plan, you also get a care coordinator. This person makes sure that you maintain your health and assists you in following guidelines set by your physician.
  • Like other Medicare Advantage Plans, you can access certain healthcare services not covered by Original Medicare, such as dental, vision, or hearing treatments. Gym memberships may also be included.

We at World Financial Solutions pride ourselves in being Medicare specialists. If you are unsure of which Medicare Advantage Plan is right for you, give us a call at 281-639-7787 or send an email to

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We are not connected with or endorsed by the United States government or the federal Medicare program.