Medicare Special Needs Plans

Overview

Medicare Special Needs plans are a type of Medicare Advantage plan for people who receive both Medicare and Medicaid (also referred to as "dual eligible"), live in an institution, or who have certain chronic conditions. The UnitedHealthcare® Special Needs plans combine all the benefits of Original Medicare (Parts A and B) with prescription drug coverage (Part D). Many plans have a $0 to low monthly premium*, beyond what you pay for Part B. Depending on the specific plan, benefits may also include care coordination, routine vision and dental coverage, credits to purchase everyday health items like vitamins, first aid supplies, and dental care products, and transportation to your medical appointments.

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* In a Dual Eligible Special Needs plan, the premiums, copayments, coinsurance and deductibles may vary based on your income and Medicaid status. Please contact the plan provider for specific details. What does dual eligible mean?

There are three types of Medicare Special Needs plans.

  • Plan Type

  • Eligibility
    Criteria

  • Network

  • Primary Care Physician

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  • Prescription
    Drug Coverage

Dual Eligible Plans

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Individuals who receive both Medicare and Medicaid ("Dual Eligible")

You generally must get your care and services from providers in the plan's network. Some plans also provide out-of-network coverage, usually at a higher cost.

Generally, yes.

Yes

Institutional
Plans

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Individuals who reside in nursing homes.

You generally must get your care and services from providers in the plan's network. Some plans also provide out-of-network coverage, usually at a higher cost.

Generally, yes.

Yes

Chronic Condition Plans

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Individuals with severe or disabling chronic conditions.

You generally must get your care and services from providers in the plan's network. Some plans also provide out-of-network coverage, usually at a higher cost.

Generally, yes.

Yes

New to Medicare

Choosing the right Medicare plan or plans can be complicated. Get guidance on choosing a plan to help you decide.

Choose between Original Medicare and a Medicare Advantage plan

How Medicare Works

Understanding Medicare plans can be complicated. Learn how Medicare works to help you decide whether you need a Special Needs plan.

Get more information about Medicare Special Needs plans

Learn how the parts of Medicare work together

Find Medicare Advantage Plans in Your Area

Find Medicare Prescription Drug Plans in Your Area

Find Medicare Special Needs Plans in Your Area

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Example: 55105 look up ZIP code

Questions?

Call UnitedHealthcare at:

1-877-596-3258
 (TTY 711)

Hours: 8 a.m. - 8 p.m. local time,
7 days a week

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