Medicaid Medicare Your Coverage Options

What’s a Medicare Special Needs Plan?

Written by Diane Archer

Medicare offers commercial health insurance coverage to help people with special needs through a special type of Medicare Advantage Plan. These Medicare Special Needs Plans are only available in certain areas. And, each one is designed to meet the needs of people with particular conditions. Keep in mind though that if you enroll in a Medicare Special Needs Plan, you will only be covered for care from doctors and hospitals in its network and may have high out-of-pocket costs.

Who can enroll in a Medicare Special Needs Plan? A Medicare Special Needs Plan is exclusively for people with who have particular disabling conditions that the health plan is designed to address, people with both Medicare and Medicaid and nursing home residents or other people need an institutional level of care.

What are your costs in a Medicare Special Needs Plan? As with all Medicare Advantage plans, your costs will vary depending upon the Special Needs Plan you join and the care you use. However, if you enrolled in Medicaid, you should have no out-of-pocket costs so long as you use network providers. Each Special Needs Plan sets premiums, copays and deductibles differently. All SNPs must provide Medicare Part D drug coverage, but each may cover a different array of drugs and set different copays. 

What are your additional benefits in a Medicare Special Needs Plan? Medicare Special Needs Plans should offer care management and care coordination services to help you better manage your conditions. But, each one is different. If you are considering one of these plans, you should make sure you understand what additional benefits will be available to you, your out-of-pocket costs, and any restrictions on your access to care, including a requirement that you get a referral from a primary care doctor in order to see a specialist.

Before enrolling in a Medicare Special Needs Plan, make sure you know the tradeoffs between enrolling in that plan and enrolling in traditional Medicare, which covers your care from most doctors and hospitals anywhere in the U.S. Click here to learn these key differences.

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