A Special Needs Plan provides Medicare Advantage coverage while tailoring benefits, provider networks, and care coordination to the population the plan serves.

There are three primary types:

All Medicare Special Needs Plans include Medicare Part D prescription drug coverage.

If you qualify for both Medicare and Medicaid, you may be eligible for a D-SNP. These plans are specifically designed for people who receive benefits through both programs. Depending on your level of Medicaid eligibility and the plan available in your area, Medicaid may also help with Medicare premiums or other Medicare costs.

A C-SNP is designed for people with certain severe or disabling chronic conditions. The plan's benefits, provider network, and care coordination are tailored around the health needs of the population it serves. Not every chronic condition qualifies, and not every C-SNP covers every qualifying condition — the condition must meet the eligibility requirements of the specific plan.

An I-SNP is designed for certain Medicare beneficiaries who live in qualifying long-term care facilities or who require an institutional level of care. This can include some people living in nursing facilities as well as certain individuals living in the community who meet institutional-level-of-care requirements.

Special Needs Plans Are Still Medicare Advantage Plans

SNPs are a type of Medicare Advantage plan. That means we still need to consider many of the same factors we would evaluate with any other Medicare Advantage plan. The difference is that eligibility is limited to people who meet the plan's specific requirements.

• Doctors and specialists
• Provider networks
• Hospitals and facilities
• Prescription drugs
• Pharmacy costs
• Copays and coinsurance
• Maximum out-of-pocket exposure
• Prior authorization
• Additional benefits

Could You Qualify for a Special Needs Plan?

Tell me if any of these apply to you:

• You have Medicare and Medicaid
• You receive help from Medicaid paying Medicare costs
• You have a significant chronic or disabling health condition
• You live in a nursing or long-term care facility
• You require an institutional level of care while living in the community

There may be Medicare Advantage options specifically designed for your situation. Eligibility, benefits, and plan availability vary by plan and service area.