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Special Needs Plans

Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage Plan that limits its membership to individuals with specific diseases or characteristics. These plans specifically tailor their benefits, prescription drug formularies, and provider networks to meet the needs of each beneficiary they serve.

There are three types of Special Needs Plans to take note of:

  • D-SNP: Dual eligible for Medicare and Medicaid.
  • C-SNP: You have one or more of the qualifying disabling or severe chronic conditions.
  • I-SNP: You live in an institution, such as a nursing home, or you require nursing care at home.

Some of the extra coverage and benefits that a SNP can provide includes:

  • Dental, vision, and hearing coverage
  • Transportation to doctor visits 
  • Adult daycare services
  • Fitness memberships
  • Nutrition programs 
  • Wellness programs 

Enrollment

To first be eligible for a SNP, you must be enrolled in Original Medicare. You cannot drop your Original Medicare coverage, otherwise you will not be eligible for a SNP.

You can enroll in a SNP during specific enrollment periods:

  • Initial Enrollment Period: The Initial Enrollment Period (IEP) is a seven-month period that starts three months before your 65th birthday month and ends three months after.
  • Annual Election Period: The Annual Election Period (AEP) lets Medicare beneficiaries change their Medicare coverage from October 15 to December 7.
  • Medicare Advantage Open Enrollment Period: The Medicare Advantage Open Enrollment Period starts from January 1 and ends March 31. You can only use this period if you’re already enrolled in a Medicare Advantage Plan, but when you are, it will allow you to switch to another Medicare Advantage Plan.
  • Special Enrollment Period: You can use this enrollment period to switch, join, or drop your Medicare Advantage plan or Medicare prescription drug coverage. You can do this one time during each of these specific periods:
    • January – March
    • April – June
    • July – September

If you make a change during the Special Enrollment Period, this change will become effective on the first day of the following month. If you want to make another change, you will have to wait until the next period to do so. Do note that you can’t use this enrollment period from October to December. However, everyone with Medicare can make changes to their coverage from October 15 to December 7 because this is when the Annual Election Period takes place. Any changes during AEP will take effect on January 1.

We Can Help

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Need help?

If you are unsure if you qualify for a SNP, reach out to Rothrock Insurance Solutions today. We can help you determine your eligibility, as well as help you determine when you should enroll.