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Special Needs Plans

Medicare Special Needs Plans (SNPs) provide coverage for those with Medicaid or chronic health needs. There are two types of SNPs—Dual-Eligible Special Needs Plans (D-SNPs) and Chronic Condition Special Needs Plans (C-SNPs). Let’s take a look at SNPs to better understand the coverage they offer, their cost, and to determine your eligibility.

What Are Special Needs Plans and How Do They Work?

Medicare Special Needs Plans (SNPs) are part of Medicare Advantage. They work to specify your coverage to care for particular diseases and medical needs. Your plan’s benefits, then, are tailored exactly to you.

Because they are a part of Medicare Advantage, you will receive all of its benefits at little to no cost. These benefits may include (but are not limited to):

  • $0 monthly premiums
  • Care coordination
  • Vision and hearing benefits
  • Over the counter quarterly benefits
  • Transportation benefits
  • Telehealth services
  • Gym memberships
  • Part D coverage

There are two main SNPs that you may qualify for, each of which geared towards particular healthcare and financial needs:

  • Chronic Condition SNP (C-SNP): Provides coverage for the chronically ill
  • Dual-Eligible SNP (D-SNP): Provides coverage for those enrolled in both Medicare and Medicaid

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Chronic Condition SNPs (C-SNPs)

You may qualify for a C-SNP based on your health condition. Generally, this plan’s eligibility is based on specific diseases or conditions considered fatal or existing throughout one’s lifetime. There are five different qualifying groups for C-SNPs:

  • Group 1: Diabetes mellitus and chronic heart failure;
  • Group 2: Chronic heart failure and cardiovascular disorders;
  • Group 3: Diabetes mellitus and cardiovascular diseases;
  • Group 4: Diabetes mellitus, chronic heart failure, and cardiovascular diseases; and
  • Group 5: Stroke and cardiovascular diseases.
Dual-Eligible SNPs (D-SNPs)

Eligibility for a D-SNP is based on financial need and Medicaid status. If you qualify for and receive both Medicare and Medicaid, you may therefore be eligible for a D-SNP.

You may also qualify for a D-SNP if:

  • You receive Medicaid benefits
  • You are a Qualified Medicare Beneficiary (QMB) without other Medicaid, or you receive QMB Plus 
  • You are a Specified Low-Income Medicare Beneficiary (SLMB) without other Medicaid, or you receive SLMB Plus
  • You are a Qualifying Individual (QI)
  • You are a Qualified Disabled and Working Individual (QDWI)
Need Help Understanding Your SNP Options?

Choosing the right Medicare plan is not a walk in the park—knowing your eligibility for plans such as SNPs can seem impossible. But, with the help of World Financial Solutions, it doesn’t have to be. For a free consultation, give us a call at 281-639-7787.