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Medicare - Special Needs Plans
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Important Points
Special Needs Plans (SNPs) are a type of Medicare Advantage plan.
SNPs are plans that coordinate care to individuals with specific needs or situations.
There are three types of SNPs: Chronic Illness (C-SNP), Dual-Eligible (D-SNP), and Institutional (I-SNP).
Special Needs Plans (SNPs) are a type of Medicare Advantage plan that provides coordinated care to individuals with specific needs or situations. Like most Advantage plans, SNPs will have a network, either an HMO or PPO.
Membership in a SNP plan is limited to individuals who have specific illnesses, chronic conditions, or eligibility for both Medicare and Medicaid. Every SNP plan must include all of the same services as Medicare Part A & B.
Special Needs Plans tailor their benefits, network, and drug formulary to meet the needs of beneficiaries who have these specific health conditions or situations. Every SNP plan includes a built-in Part D prescription drug plan.
Let's review the types of Special Needs Plans and how they work:
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Chronic Illness Special Needs Plan (C-SNP)
A Medicare SNP plan based on certain health conditions is a plan specifically designed to provide support for beneficiaries with a chronic illness. For instance, the C-SNP may provide access to a group of providers that specialize in treating these specific illnesses.
The providers work together to coordinate your care and will often assign a care coordinator or case manager to assist you in keeping healthy, managing your chronic health condition, and following your doctor's orders. The case manager may also help you to access community resources or get the right prescriptions in a timely manner.
The prescription drug formulary that is built into the plan is likely to offer an expanded list of drugs that treat your particular health condition.
To qualify for a C-SNP, you must have one or more of the health conditions listed below:
Autoimmune disorders
Alzheimer's and/or Dementia
Cancer
Cardiovascular disease, stroke, or chronic heart failure
Diabetes
End Stage Renal Disease requiring dialysis
Hematologic disorders
HIV or AIDS
Lung Disorders (like COPD)
Chronic or disabling mental illness
Neurologic conditions
In order to join a C-SNP plan, your doctor will need to complete a chronic condition verification form at the time that you enroll. Your agent can provide you with the form and your doctor can complete the form and return it to verify your eligibility.
C-SNP plans vary by county. Insurance carriers can choose where they will offer certain plan designs, so you may or may not be able to find a C-SNP plan in your area that specializes in the specific condition that you have. Check with one of our Medicare brokers to see what is offered in your area.
Dual Eligible Special Needs Plan (D-SNP)
Some Medicare beneficiaries may also qualify for Medicare. Medicaid is a federal and state health insurance program for people with low incomes or resources.
If you do qualify for both, you can have Original Medicare function as your primary insurance and Medicaid function as your secondary coverage, or you can enroll in a D-SNP plan.
Individuals who are entitled to full Medicaid can expect to spend little to nothing on deductibles, copays, and coinsurance for Medicare Part A and Part B services provided by the plan. Many plans also have a $0 premium because Medicaid will pay any plan premium for you. If you only qualify for partial Medicaid you may have to pay some cost-sharing.
D-SNP plans also typically offer a lot of extra benefits. These might include:
Gym memberships
Quarterly benefits for over the counter products and healthy groceries
Routine dental, vision, and hearing benefits
Telemedicine services
Transportation to and from doctor appointments and pharmacy visits
The insurance carrier or your insurance agent will need to verify your eligibility for Medicaid before they can enroll you into a D-SNP plan.
Institutional Special Needs Plan (I-SNP)
Individuals on Medicare that live in an institution, such as a memory care center, assisted living center, or nursing home, may qualify for an I-SNP plan.
I-SNP plans are similar to the Chronic Illness SNP, but they place their focus on dealing with the coordinated care of someone who is no longer living independently. The beneficiary must be expected to live in the institution for at least 90 days in order to qualify for an I-SNP plan.
Enrolling in a Special Needs Plan
In order to qualify for enrollment in a Special Needs Plan, you must live in the plan's service area and be enrolled in both Medicare Part A & Part B. You must continue to pay your Part B premium to Social Security while you are enrolled in the plan (unless this is covered for you by Medicaid).
Additionally, you are required to pay any monthly premium that the plan itself charges for the SNP. Finally, you will pay the regular cost-sharing expenses like deductibles, copays, and coinsurance. These amounts will be available for you to review in the plan's Summary of Benefits. Be sure to look over the plan's Summary of Benefits before enrolling.
You are allowed to enroll in a Medicare SNP during your Initial Enrollment Period or during any Annual Enrollment Period. Some individuals may also qualify for a Special Enrollment Period during the year in certain circumstances. Some of these situations include:
Being diagnosed with a chronic condition that qualifies you for a C-SNP plan
Moving into, living in, or moving out of an institution
Moving outside of your current plan's service area
Qualifying for Medicaid
If you find yourself in a situation where you lose your eligibility for a Special Needs Plan, you will be granted a grace period in which you can leave the plan and join another plan or return to Original Medicare.
Want to Learn More About Special Needs Plans?
Our agents work with a number of Medicare Advantage Special Needs Plans. Give our team a call at (866) 440-1885 to see if we can help you find the right Special Needs Plan for you.
Key Points
You must enroll in a SNP during a qualifying election period.
Not all insurance carriers offer SNPs, so the plans available to you will depend on your zip code.
Individuals must meet the requirements of a specific SNP plan in order to enroll.
At Mohring Insurance Services LLC, we are happy to offer assistance with Medicare when you choose to enroll. Give us a call at (866) 440-1885, or to schedule a free consultation, click the link below:
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