Special Needs Plans

Medicare Special Needs Plans

A Medicare Special Needs Plan is another type of Medicare Advantage Plan. This plan is only for those who have a specific disease or health condition. Not only that they work around the client to best meet the needs of the person on the plan. 

Who you can receive healthcare from

Care and services must be through the doctors and hospitals within the Medicare SNP network. The people on SNP go to specialists who deal specifically with diseases and conditions they might have. 

Drug Coverage

With a Medicare Special Needs Plan, it is mandatory that they provide Medicare drug coverage. 

Primary Care Doctor

With the SNP plan, choosing a primary care doctor will be required, or choosing a care coordinator to help with health care can be made. 


A referral is needed to see any specialists within the SNP network. You do not need a referral for a yearly mammogram screening or a pap test and pelvic exam that is in-network. 

What you need to know

The planned membership is limited only to certain groups that meet the criteria to apply;

  • Those who live in health institutions, and or need assistance with living at home
  • Those eligible for Medicaid and Medicare
  • Those with chronic or conditions that disable the person from being well, ex. (HIV/AIDS, Dementia, etc.) 

If one is one Medicaid and Medicare then be sure to check and see if healthcare providers accept Medicaid. Make sure to do research to see if the SNP providers are within the area you reside in.