Home Life Insurance Particular Wants Plans: A Medicare Buyer Query

Particular Wants Plans: A Medicare Buyer Query

Particular Wants Plans: A Medicare Buyer Query


What You Have to Know

  • SNPs are specialised Medicare Benefit plans.
  • They serve folks with designated monetary, well being or residing conditions.
  • About 4.6 million of the 30 million Medicare Benefit enrollees have SNP protection.

In relation to particular person well being, there isn’t any one-size-fits-all.

Many Medicare beneficiaries are managing a number of points or produce other circumstances of their life that have an effect on their capacity to entry well being care.

In that case, they could want extra than simply a normal Medicare plan to obtain ample remedy.

Luckily, since 2006, Medicare Benefit has supplied particular wants plans (SNPs) that present further protection to certified recipients to assist guarantee beneficiaries are capable of get the care they want no matter their monetary, well being, or residing state of affairs.

In 2022, of the greater than 28 million folks enrolled in Medicare Benefit plans, greater than 4.6 million members are additionally in SNPs.

That’s why it’s essential for brokers to know what SNP choices can be found, the right way to know if their purchasers qualify, and the way they’ll enroll in a particular wants plan.

Brokers must get the complete image of their purchasers’ wants and conditions in order that they’ll correctly advise their purchasers on not solely what their choices are in terms of Medicare plans, but in addition which supplemental applications, akin to SNPs, they’ll make the most of to take advantage of their care.

The Query:

Does your consumer qualify for a Medicare particular wants plan?

The Reply:

In 2003, the Medicare Modernization Act established SNPs they usually turned out there to all Medicare beneficiaries in 2006.

Since then, beneficiaries have used SNPs to entry further medical and prescription drug protection, dental, listening to and imaginative and prescient advantages.

In 2010, 1.3 million Medicare Benefit beneficiaries had been enrolled in SNPs.

By 2022, this quantity had tripled.

There are three sorts of SNPs.

Every is designed to deal with the wants of Medicare beneficiaries who’re managing particular circumstances as a result of persistent well being circumstances, institutional residing, or monetary circumstances that concurrently qualify them for Medicaid help.

Relying in your consumer’s well being, housing, and monetary conditions, they could qualify for an SNP along with their Medicare Benefit plan.


The primary and most typical subset of the SNP umbrella is the dual-eligible particular wants plans (D-SNPs).

These plans apply to Medicare beneficiaries who additionally qualify for Medicaid advantages as a result of restricted revenue – a state of affairs that’s typically made worse by well being points that restrict an older particular person’s capacity to work.

Final yr, 61% of all SNP enrollees had been lined by D-SNP advantages.

D-SNPs work along with state Medicaid applications to coordinate advantages for sufferers who qualify for each applications.

By means of D-SNPs, Medicare beneficiaries can obtain further advantages, akin to a flex card that covers groceries and will also be utilized to over-the-counter medicines and transportation, decreased or waived copayments for prescription treatment, and value sharing or Medicaid help in paying Half B premiums and different Medicare service prices.

The second kind of SNP, known as a persistent situation particular wants plan (C-SNP), applies to sufferers with sure long-term medical circumstances.


In 2022, greater than 95% of C-SNP enrollees had been receiving remedy for diabetes or cardiovascular circumstances, however your consumer can also qualify if they’ve respiratory points, end-stage renal illness, or sure different persistent circumstances.



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