Each year the Medicare Advantage open enrollment period is October 15 through December 7. Ideally, a person would enroll for Medicare Advantage during this time however there are certain exemptions put into place to make sure proper care is given to those in need. These exemptions include Special Needs Programs(SNPs) and special enrollment periods(SEPs). This article will specifically cover switching to Medicare Advantage mid-year through a Special Needs Plan (SNP).


By switching to Medicare Advantage through a Special Needs Plan, members avoid the Medicare Advantage “donut hole” coverage gap. The gap refers to a limit on how much a drug plan will pay for medications after a certain amount. For the 2023 the coverage gap starts at $4660. For many seniors and those with specific or disabling conditions, paying the out of pocket costs for medication is impossible. SNPs have expanded prescription medication and are the best option for these individuals. 

Medicare Special needs plans(SNPs) offer Medicare Advantage Coverage

A Medicare Advantage Plan allows patients to receive care through a network of providers that contract with Medicare. Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage Plan that serves seniors and other individuals with chronic or disabling conditions.

There are three different types of Special Needs Plans:

  1. Chronic Condition SNP (C-SNP)
  2. Dual Eligible SNP (D-SNP)
  3. Institutional SNP (I-SNP)

Eligible Individuals can Switch Outside of Open Enrollment With a Medicare Special Needs Plan(SNP)

If an eligible member needs to switch to a Special Needs Plan they can do so anytime without penalty. This is extremely important to make sure that suddenly have an increase in healthcare costs. A person moving into a nursing facility or someone diagnosed with a disabling condition needs coverage immediately. Special needs plans have open enrollment to ensure these individuals receive the care and prescription medication they need. 


Special Enrollment Periods

There are several instances that qualify a person for a Special Enrollment Period.

More information about Special Enrollment Periods can be found by visiting Medicare.gov or calling 1-800-Medicare (1-800-633-4227). 

Determining Special Needs Plan Eligibility

Seniors eligible for both Medicare and Medicaid can enroll in a Special Needs Plan. Unlike standard Medicare Advantage plans, an eligible individual can enroll at any time. There are additional groups that are eligible for a Special Needs Plan. These groups include individuals living in nursing homes, home nursing care recipients, and those with specific or disabling conditions. 

If you have questions about Medicare, or need assistance enrolling, please reach out to us here at Meadowcrest Family Physicians. Our commitment to improving your health doesn’t stop at the office. We strive to be available in any way possible to assist you. We believe strongly in Medicare Advantage programs as we have seen the benefit they offer our patients.

Funding for Special Needs Plans and Member Premiums

An SNP offers coverage for all your healthcare services under one affordable plan.  Funding for Medicare Special needs plans comes primarily from Medicare. As with Medicare Advantage, SNP recipients are required to cover a premium(copay) for their health care services. 

Special Needs Plans Have Reduced Premiums and Increased Prescription Drug Coverage

The goal of a Medicare Special Needs Plan is to make sure individuals with serious health conditions can afford the healthcare they need. The cost of staying on private insurance can be far too high for those with chronic illnesses and other conditions. With most other healthcare providers, out-of-pocket expenses can become prohibitively expensive. Medicare SNPs have an out-of-pocket cap and premiums are often less than typical Medicare Advantage plans.  

Centers for Medicare & Medicaid Services says “All SNPs must provide Part D prescription drug coverage because special needs individuals must have access to prescription drugs to manage and control their special health care needs.”

Special Needs Plan Members Avoid the Medicare Advantage Donut Hole

The primary benefit of a Special Needs Plan is that members will avoid the Medicare Advantage prescription drug coverage gap. The coverage gap also known as the “donut hole” refers to a limit to how much a drug plan will pay for prescription medications after a certain amount. The coverage gap begins after a member and their drug plan have spent $4,660 on covered drugs in 2023. This could leave someone paying way more than they can afford if they are prescribed expensive medications.

We at Meadowcrest Recommend Medicare Advantage Plans Including Special Needs Plans.


The doctors and staff at Meadowcrest Family Physicians are dedicated to offering the best care we can to our patients. We understand that the Medicare system and health insurance can be very confusing. If you or a loved one is having difficulty with Medicare benefits, reach out to us and we will be glad to help.