This study explored the perceptions and needs of special education teachers regarding the operation plans and support for high school credit elective courses for students with special needs in inclusive education settings. A survey was conducted targeting 195 high school special education teachers across the country. The results of this study showed that teachers perceived that elective subjects can provide customized academic and career guidance for students with disabilities however, they also noted that the low desire of students with disabilities in various subjects and range of participating students should be taken into consideration. Additionally, it was recognized that additional special education teachers and specific guidelines are needed to operate elective subjects. In the case of online elective courses, it was recognized that blended learning and the development of online contents for different types of disabilities are necessary that it is appropriate to operate inter-school co-curricular programs as blended co-curricular programs within regular school hours on a fixed base school. For out-of-school education, it was recognized that the district office of education should provide both out-of-school education and classes taught by external experts in schools, and that it is necessary to secure out-of-school educational institutions and manage their quality. In order to operate elective courses for students with special needs in an inclusive education environment, the school-level support for students’ mobility is important, moreover, itinerant special teachers are needed to provide elective subjects at both the district and national levels. Based on these results, implication for the operation of high school credit elective courses for students with special needs in inclusive education settings and suggestions for further research are discussed.