What is a Special Needs Plan for Texans?

A special needs plan (SNP) is a Medicare Advantage (MA) coordinated care plan (CCP) specifically designed to provide targeted care and limit enrollment to special needs individuals. A special needs individual could be any one of the following:

• An institutionalized individual,
• A dual eligible, or
• An individual with a severe or disabling chronic condition, as specified by CMS.

An SNP may be any type of MA CCP, including either a local or regional preferred provider organization (i.e., LPPO or RPPO) plan, a health maintenance organization (HMO) plan, or an HMO Point-of-Service (HMO-POS) plan. There are three different types of SNPs:

• Chronic Condition SNP (C-SNP)
• Dual Eligible SNP (D-SNP)
• Institutional SNP (I-SNP)

There are three types of Special Needs Plans (SNPs) for Texans available:

Chronic-Condition Special Needs Plans (C-SNP): These plans serve beneficiaries with certain severe or disabling chronic conditions, such as cancer, chronic health failure, or HIV/AIDS. Chronic-Condition Special Needs Plans may target a single chronic condition or more than one condition.

Institutional Special Needs Plans (I-SNP): These plans serve those living in an institution (such as a nursing home) or who need nursing care at home.

Dual-Eligible Special Needs Plans (D-SNP): These plans serve people who have both Medicare and Medicaid benefits (also known as “dual eligibles”).

If you fall into any of these categories, you may have unique healthcare needs that a Special Needs Plan may be better equipped to address. For example, some Special Needs Plans offer a larger network of providers that specialize in treating your condition or have formularies that are tailored to cover the prescription drugs typically prescribed for your particular illness.

Eligibility for Special Needs Plans for Texans

To enroll in a Medicare Special Needs Plan, you must meet the following eligibility requirements:

• Be enrolled in Medicare Part A and Part B.
• Live in the service area of the Special Needs Plan.
• Meet the eligibility requirements that the Special Needs Plan targets (i.e., live in an institution; have Medicare and Medicaid, or have the chronic conditions(s) that the plan targets).

Medicare beneficiaries with end-stage renal disease are typically not allowed to enroll in a Medicare Advantage plan, with some exceptions. However, if there is a Special Needs Plan targeting end-stage renal disease beneficiaries in your service area, you may be eligible to enroll in this type of plan.

What do Special Needs Plans for Texans Cover?

Special Needs Plans cover the same health care services that all Medicare Advantage plans must include Medicare Part A and Part B. Some SNPs may also cover extra services tailored to the specific group they’re designed to serve; however, all Special Needs Plans are required to provide prescription drug coverage. You’ll want to review each plan you may qualify for carefully to learn exactly what benefits and services will be covered.

What extra benefits may be included with a Dual Special Needs Plan for Texans?

Dental, vision, and hearing coverage, care coordination via a personal care coordinator, personal emergency response system (PERS), telehealth options such as virtual medical visits with your doctor, credits to buy health products, plus transportation assistance, and more. These are just a handful of examples of the extra benefits Dual Special Needs Plans typically include. Each plan is different, so be sure to look at what’s available where you live.

What happens to my Medicaid benefits?

A Dual Special Needs Plan doesn’t replace your Medicaid plan or change your Medicaid eligibility. You’ll keep the same Medicaid plan you have today, and you’ll still get all the same Medicaid benefits you get now.

 Remember, plan benefits can change from year to year. Make sure you understand how a plan works before you join.