Seniors suffering from debilitating chronic health conditions may be eligible to join a Medicare-approved Special Needs Plan (SNP). An SNP provides additional benefits above and beyond Original Medicare, offering seniors with special care requirements the treatment and services they need.

Special Needs Plan

Treatment of certain chronic health conditions such as cancer or dementia may require additional services above and beyond that which Medicare provides. For many seniors, the extra cost associated with treatment is a burden and Special Needs Plans address these concerns. Most benefits provided by an SNP are paid in full for recipients who are enrolled in both Medicare and Medicaid. However, for seniors who do not qualify for Medicaid, participating in an SNP costs about the same as enrollment in a typical Medicare Advantage plan. 

Eligibility

To be eligible to join a Medicare Special Needs Plan, you must be enrolled in Medicare Part A and Part B, reside in the plan’s service area, and meet specific medical requirements. Seniors with a disabling chronic condition or who live in a nursing home, require in-home care or currently receive both Medicare and Medicaid benefits may qualify. SNPs may not be available in all states as insurance companies providing benefits decide which counties will offer coverage.

What Qualifies as a Chronic Condition?

Many seniors face chronic health conditions with age. However, to qualify for a Special Needs Plan, seniors must have one or more of the following chronic conditions:

Alcohol or drug dependence

Hematologic disorder

Autoimmune disorder

HIV/Aids

Cancer

Chronic lung disorder

Cardiovascular disorder

Disabling mental health conditions

Chronic heart failure

Neurologic disorder

Dementia

Stroke

Diabetes

End-stage liver disease

References:

https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/special-needs-plans.html

https://www.medicare.gov/Pubs/pdf/11302.pdf

MUC14-2016-BCBS