What Are Medicare Special Needs Plans?

Medicare Special Needs Plans (SNPs) were created by Congress in 2003, with the passing of the Medicare Modernization Act. The aim of the Special Needs Plan was to provide high quality care to those with serious health conditions. In 2007, there were 477 SNPs in place operating in 43 U.S. states.

Membership

• Enrollment in a Medicare Special Needs Plan is restricted to people who have specialized health care needs and there are three types of eligibility criteria. Firstly, a SNP is available to those who permanently reside in a nursing home or require nursing care at home. Secondly, people who already receive both Medicare and Medicaid are eligible for the SNP plan, known as dually eligible beneficiaries. Thirdly, those who have one or more chronic or disabling conditions such as diabetes, congestive heart failure, end-stage renal disease, HIV/AIDs or a mental health condition are eligible for a Medicaid SNP.

Coverage

• Medicare SNPs are designed to cover all the costs associated with the patients' specialized health needs. These include Medicare Part A Services, which cover the costs for in-patient hospital care, a skilled nursing facility, hospice or equivalent health care at home. The SNP also covers Medicare Part B costs for doctors' services, outpatient care and some preventive services like flu shots. With a Medicare SNP, members are also covered for the cost of prescription drugs, known as Part D.

Care

• Many members enrolled in the Medicare Special Needs Plan will be allocated a Care Coordinator, a main feature of the SNP plan. These are people who ensure that SNP members are getting the right care and information about their condition and who can ensure that a doctor's orders are being carried out. Another important aspect of care under the Special Needs Plan is that members are only eligible to be treated by doctors and hospitals within Medicare's SNP network. The only exception to this rule is emergency or urgent care for a problem that needs immediate attention, such as out-of-area dialysis for end-stage renal disease.