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What is a Medicare Special Needs Plan?

Posted by David Ghiorso, CPA, March 22, 2022

Almost everyone is eligible for Medicare upon their 65th birthday. Medicare will pay for a considerable portion of your healthcare needs throughout the rest of your lifetime, but you will pay a premium for Part B along with a Part D plan if you enroll in one. Or you might pay a premium for a Medicare Advantage plan. Copayments and deductibles also apply.

But for some people, the cost of premiums, copayments, and deductibles is much more challenging. If you also qualify for Medicaid along with your Medicare, you might be eligible for what is called a Special Needs Plan. Those who reside in long-term nursing facilities, need skilled nursing care at home, or have certain chronic or disabling conditions like diabetes or end-stage renal disease might also qualify.

A Special Needs plan is a type of Medicare Advantage plan that is specifically tailored to the group enrolled in it. The plan helps you to manage the amount you will pay out of pocket for medical services and may include additional benefits.

Like other Medicare Advantage plans, a Special Needs Plan usually works within a network. You will need to choose a primary care physician and will often need to seek a referral for specialized services.

If you are eligible for both Medicare and Medicaid and would prefer a plan that is more specifically tailored to your needs, talk to an insurance broker about Special Needs Plans.

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