Call (916) 704-1174 to speak with a licensed insurance agent.

Call (916) 704-1174 to speak with a licensed insurance agent.

What is a Medicare Special Needs Plan?

Posted by David Ghiorso, CPA, January 25, 2023

The goal of a healthcare plan is always to help you obtain the healthcare you need while managing out-of-pocket expenses. And because healthcare needs are highly unique depending upon each individual, it’s no wonder that there is no single healthcare plan that is right for everyone. That is especially true with regard to Medicare plans, because we tend to develop a variety of needs later in life. A Medicare Special Needs plan is designed to suit you as an individual.

Medicare Special Needs plans are Medicare Advantage plans that have been designed specifically to provide for the needs of people diagnosed with certain medical conditions. These HMO or PPO plans are arranged around the benefits, providers, and medications best suited to a group of people who share certain diagnoses or characteristics.

The following Medicare beneficiaries might qualify for a Special Needs Plan:

  • Those who live in a nursing home or who live at home but require in-home nursing care
  • Those who qualify for both Medicare and Medicaid
  • Those who are diagnosed with certain conditions, such as diabetes, HIV/AIDS, end-stage renal disease, dementia, or chronic heart failure

 

A Special Needs Plan will provide benefits targeted to member needs, including care coordination services. All of these plans provide prescription drug benefits (Medicare Part D). Some will require you to have a primary care doctor, while others will not. If you qualify on the basis of enrollment in both Medicare and Medicaid, you should check to be sure your preferred providers accept Medicaid.

A Special Needs Plan can help those with certain conditions manage their care more effectively and affordably, but the plan might not be right for every person in every geographic area. Consult with one of our qualified brokers to learn more about Special Needs Plans before making the decision to enroll in one.

Need more information?

Contact us online to learn more

Contact Us

Close Accessibility Tools
Accessibility Controls Reset
Content Adjustments
Font Size

Default

Line Height

Default

Content Scaling

Default

Highlight Titles
Highlight Links
Highlight Forms
Align Left
Align Center
Align Right
Focus Mode
Color Adjustments
Desaturate
Monochrome
Contrast

Default

Saturation

Default

Accessibility Statement

Despite our attempts to make this website accessible for everyone, there may still be some pages or sections that are not completely accessible, are in the process of becoming accessible, or do not have a suitable technological solution to make them accessible. Nevertheless, we are always striving to enhance our accessibility by adding, updating, improving its options and features, and incorporating new technologies.

We want to provide our users with the best experience possible, so we strive to support as many browsers and assistive technologies as possible.

If you wish to contact this website's owner, please use the contact form on the website.

Our User Interface Adjustment Options

Font adjustments - With this tool, users can modify font size, style, letter spacing, and line height for improved alignment and readability.

Color adjustments - Users can customize their color contrast profiles to light, dark, desaturated, and monochrome.

Content highlighting - Users can prioritize key elements such as links, forms, and titles.

Content focus - Users can enable focus mode to highlight the current page information based on their mouse movement.

Close