Special Needs Plans are a type of Medicare Advantage Plan and are designed to meet the needs for specific groups of individuals. Most SNPs have a network of providers that beneficiaries should use whenever possible. Typically, you will be required to get your care from a doctor or facility that is in the plan’s network. All Special Needs Plans must also provide coverage for prescription drugs.

SNPs are limited when it comes to enrolling individuals into the plans. Enrollment into these plans are limited to:

  • Individuals who live in institutions or require nursing care at home (I-SNP)
  • Individuals with chronic or disabling conditions (C-SNP)
  • Individuals who are eligible for both Medicare and Medicaid (D-SNP)

Other qualifications for SNPs include living in the plan’s service area, being enrolled in Original Medicare (Parts A and B), and being a U.S. citizen or permanent resident.

What are Dual-Eligible Special Needs Plans?

As mentioned above, Dual-Eligible Special Needs Plans (D-SNP) are a type of Special Needs Plan that enrolls individuals who are eligible for both Medicare and Medicaid.

These plans combine both inpatient and outpatient coverage, as well as extra benefits, such as:

  • Dental coverage
  • Vision coverage
  • Hearing coverage
  • Prescription drug coverage
  • Fitness memberships
  • Nutrition programs
  • Wellness programs
  • Transportation for doctor visits
  • Adult daycare services

There are a few ways in which you can enroll in a D-SNP. If you are newly eligible, you can enroll at any point in the year with no restrictions. If you currently have Medicare and Medicaid or are already in a D-SNP, you can change plans during a Special Enrollment Period or the Annual Enrollment Period.

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Eligibility for Medicare

Medicare is available to individuals who are 65 and older, younger than 65 with a disability, or individuals who have End-Stage Renal Disease. 

You can enroll in premium-free Medicare Part A if you are 65 or older and if you or your spouse paid Medicare taxes for no less than ten years. You can also qualify for premium-free Part A and be automatically enrolled if:

  • You have received retirement benefits from Social Security or the Railroad Retirement Board
  • You are eligible to receive benefits from Social Security or the Railroad Retirement Board
  • You or your spouse worked for the government

If you are under 65, you can get premium-free Part A by:

  • Receiving disability benefits for 24 months from Social Security or the Railroad Retirement Board
  • You need kidney dialysis or need a kidney transplant
Eligibility for Medicaid

There are certain groups of people who qualify for Medicaid. Some of these groups include low-income families and individuals who get Supplemental Security Income (SSI). You must also reside in the state that you will receive Medicaid benefits from.

Other qualifications include, but not limited to:

  • Being a U.S. citizen or qualified non-citizen
  • Your income
  • Your household size
Are You Dual-Eligible?

Do you qualify for both Medicare and Medicaid and are interested in a Dual-Eligible Special Needs Plan? Midwest Trusted Benefit can help! We will make sure you get the coverage you need with the Medicare plan you deserve.