What is a Medicare Advantage special needs plan?
Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve. D-SNPs was created as a possible route to better integration between Medicare and Medicaid, in turn leading to better quality, higher value care
There are three types of Special Needs Plans (SNPs) available:
• Chronic-Condition Special Needs Plans (C-SNP): These plans serve beneficiaries with certain severe or disabling chronic conditions, such as cancer, chronic health failure, or HIV/AIDS. Chronic-Condition Special Needs Plans may target a single chronic condition or more than one condition.
• Institutional Special Needs Plans (I-SNP): These plans serve those living in an institution (such as a nursing home) or who need nursing care at home.
• Dual-Eligible Special Needs Plans (D-SNP): These plans serve people who have both Medicare and Medicaid benefits (also known as “dual eligibles”).
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If you fall into any of these categories, you may have unique health-care needs that a Special Needs Plan may be better equipped to address. For example, some Special Needs Plans offer a larger network of providers that specialize in treating your condition or have formularies that are tailored to cover the prescription drugs typically prescribed for your particular illness.
Eligibility for Medicare Special Needs Plans
To qualify for a Special Needs Plan, typically you must:
• Be enrolled in Medicare Part A and Part B.
• Reside in the plan’s coverage region.
• Satisfy the Special Needs Plan’s enrollment criteria (e.g., have the specific qualifying medical condition associated with the plan; live in an institution; or be enrolled in both Medicare and Medicaid).
Getting help with Special Needs Plans costs.
If you receive help from Medicare to pay your prescription drug costs, you probably qualify for help reducing your monthly premium.
This help doesn’t pay for everything – you must still pay your Medicare Part B premium (if it’s not paid for by Medicaid or another group).
Medicare provides “Extra Help” to pay prescription drug costs for people who have limited income and resources. Resources include your savings and stocks, but not your home or car. If you qualify, you will get help paying for your Medicare prescription drug plan’s monthly premium, yearly deductible, prescription co-payments and coinsurance. This Extra Help also counts toward your out-of-pocket costs.
Some people automatically qualify for Extra Help and don’t need to apply. Medicare mails a letter to people who automatically qualify for Extra Help.
To see if you qualify for getting Extra Help call:
• 1-800-MEDICARE (1-800-633-4227). TTY users call 1-877-486-2048. Get information 24 hours a day, 7 days a week. You can also visit www.medicare.gov to view a copy of the ‘Medicare and You’ handbook- see section ‘Programs for People with Limited Income and Resources’; or
• The Social Security Administration at 1-800-772-1213 between 7:00 a.m. and 7:00 p.m., Monday through Friday. TTY users call 1-800-325-0778; or
• Your State Medicaid Office
After you apply, you will get a letter letting you know if you qualify for Extra Help and what you need to do next.
Premiums, copays, coinsurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details
Special Needs Plans can be a good option for people with unique health needs. If you ‘d like more information about whether a Special Needs Plan might work for you or a loved one, just let us know If you ‘d prefer to speak one-on-one, contact us Medicare insurance brokers, give us a call 520-402-6002or email firstname.lastname@example.org, we’ll send you some more information; This a free consultation, no Obligation