Special Needs
Special medical situations require specialized care. Medicare Special Needs Plans (or SNPs) were created with this principle in mind.
SNP's
Special Needs plans are Advantage Plans that are tailored to meet the needs of individuals with certain health conditions or circumstances.
Similar to Medicare Advantage Plans, you must have Original Medicare Parts A and B to enroll. Some other types of Special Needs Plans include Institutional SNPs and Dual-Eligible SNPs. A patient who is expected to be institutionalized for 90 days or longer might be eligible for an Institutional SNP, designed to coordinate the care of a patient no longer living independently.
Special Needs Plan’s networks of providers, benefits, and drug formulary are all centered on the patient’s condition to provide the appropriate care. You must continue to pay your Part B premiums as well unless Medicaid eligibility covers those.
Eligibility
Qualifying for a Special Needs Plan is based on of chronic illness. You must be diagnosed with one or more of the following conditions to enroll into a Special Needs plan:
Chronic illness Special Needs plans vary state, county, and zip code, just like a Medicare Advantage plan. Therefore, not all patients with chronic conditions will be able to locate a plan designed around their needs in their area. A licensed insurance professional can offer more assistance in locating these plans.
Application
Dual-Eligible Special Needs Plans, or DSNPs, are available to individuals who qualify for both Medicare and Medicaid. Medicare is supplied from the federal government. Medicaid is supplied by your state and offer financial assistance for those with low income, to help them pay for their healthcare needs. In many cases Medicaid will pay the premiums, along with a significant portion of co-pays and deductibles. To qualify for Medicaid, call your local Social Security Office.
The benefits of a DSNP include the following:
Medicare FAQ's
You are eligible to apply for Medicare during your initial enrollment period which is a 7 month window. 3 months before turning 65, the month you turn 65 and 3 months after turning 65.
The easiest way to sign up for Medicare is online through SSA.gov or by Calling Social Security at 1-800-772-1213. You can also visit your local Social Security Office.
If you are already receiving Social Security Benefits you will be automatically enrolled into Original Medicare, otherwise you will be eligible to enroll during your initial enrollment period that starts 3 months before your 65th birthday.
If you miss your Initial Enrollment Period you can sign up during the General Enrollment period that occurs every year January 1st through March 31st. Coverage becomes effective the month following your enrollment date.
Yes, there are penalties for not signing up for Part B of Medicare and will be added to your premium.
If you need a new Medicare card you can order a replacement card by phone at 1-800-772-1213, or online at the Social Security Administration web site. Make sure you have your Medicare number ready when you call.
Medicare has neither endorsed nor reviewed this information. Not connected or affiliated with any United States Government or State agency.
We do not offer every plan available in your area. Please contact Medicare.gov, 1-800-Medicare, or your local State Health Insurance Program
(SHIP) to get information on all of your options.
© Copyright 2025 Fabian Insurance Services All rights reserved.
Website created by MedicarePRO|Marketing
