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SPECIAL NEEDS PLAN/OHP
A Special Needs Plan (SNP) is a specialized Medicare Advantage plan designed for individuals with chronic health conditions. These plans combine the benefits of Original Medicare (Parts A and B) with additional coverage like prescription drugs, dental, and vision.
To qualify for an SNP, you must be enrolled in Original Medicare and meet specific eligibility criteria related to your chronic health condition. SNPs are categorized into three main types:
Chronic Condition Special Needs Plans (CCSNPs)
Institutional Special Needs Plans (ISNPs)
Dual Eligible Special Needs Plans (DSNPs)
Chronic Condition Special Needs Plans (CCSNPs) are specifically designed for Medicare beneficiaries with chronic or severe health conditions. These plans offer specialized healthcare services tailored to the unique needs of individuals with conditions like type 2 diabetes, cancer, heart failure, HIV, and stroke. CCSNPs also provide coverage for people with a range of conditions within broader categories such as cardiovascular disease, lung disease, mental health disorders, and neurological disorders.
Chronic Condition Special Needs Plans
Institutional Special Needs Plans
Institutional Special Needs Plans (ISNPs) are designed for Medicare Advantage beneficiaries who require extended stays in medical institutions, typically 90 days or more. These plans cover the costs of care in skilled nursing facilities, long-term care facilities, and provide immediate healthcare services for individuals with psychiatric needs or intellectual disabilities.
Dual Eligible Special Needs Plans (DSNPs) are designed for Medicare beneficiaries who are also eligible for Medicaid, often referred to as dual-eligible individuals. These plans are ideal for individuals with complex healthcare needs who may have difficulty affording their medical expenses due to low income or other factors.
Dual Eligible Special Needs Plans
Eligibility and Enrollment
To be eligible for a Special Needs Plan (SNP), you must be enrolled in Medicare Parts A and B and reside within the plan's service area. Additionally, you must meet the specific eligibility requirements for one of the three types of SNPs:
Dual Eligible Special Needs Plans (DSNPs): Eligibility requires enrollment in both Medicare and Medicaid.
Chronic Condition Special Needs Plans (CCSNPs): Eligibility requires a documented chronic or severe health condition verified by a physician.
Institutional Special Needs Plans (ISNPs): Eligibility requires the need for high-level care or a long-term stay in a healthcare facility (90 days or more).
For additional information or assistance with Special Needs Plans, please contact us at
Frequently Asked Questions
New to Medicare?
What is Medicare and How Do I Qualify?
Medicare Advantage plans are offered by private insurance companies contracted through Medicare as an alternative to Original Medicare. These plans combine all of the benefits of Medicare Part A (hospital) and Part B (medical), and may also include prescription drug coverage, if they are Medicare Advantage Prescription Drug Plans.These plans combine all of the benefits of Medicare Part A (hospital) and Part B (medical), and may also include prescription drug coverage, dental or vision coverage all for an affordable and sometimes $0 monthly plan premium.
What is Medicare Advantage (Part C)?
Medicare Advantage plans are offered by private insurance companies contracted through Medicare as an alternative to Original Medicare. These plans combine all of the benefits of Medicare Part A (hospital) and Part B (medical), and may also include prescription drug coverage, if they are Medicare Advantage Prescription Drug Plans. These plans combine all of the benefits of Medicare Part A (hospital) and Part B (medical), and may also include prescription drug coverage, dental or vision coverage all for an affordable and sometimes $0 monthly plan premium.
What are Medicare Prescription Drug Plans (Part D)?
Medicare Part D plans add prescription drug coverage to Original Medicare, some Medicare Cost Plans, some Medicare Private Fee-for-Service (PFFS) Plans, and Medicare Medical Savings Account (MSA) Plans. A prescription drug plan may help you save money on existing prescriptions or on medication needs in the future.
Not affiliated with the United States government or federal Medicare program. We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.
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