what are the three types of special needs plans? three types of special needs plans
If you’re a Medicare beneficiary with one of the above circumstances, you may not realize that there are Medicare plans available that are specifically designed to help you manage the complex health challenges that may come with your situation.
Special Needs Plans tailor their benefits and services for Medicare beneficiaries with unique health or situational challenges. Here’s an overview of how they work, including what they cover, eligibility, and how to enroll. Contact Medicare insurance brokers Arizona
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3 Types of special needs plans
There are three different types of SNPs:
A special needs plan (SNP) is a Medicare Advantage (MA) coordinated care plan (CCP) specifically designed to provide targeted care and limit enrollment to special needs individuals. A special needs individual could be any one of the following:
♦ An institutionalized individual,( Institutional SNP) (I-SNP).
♦A dual eligible, SNP (D-SNP).
♦An individual with a severe or disabling chronic condition, SNP (C-SNP) as specified by CMS.
A SNP may be any type of MA CCP, including either a local or regional preferred provider organization (i.e., LPPO or RPPO) plan, a health maintenance organization (HMO) plan, or an HMO Point-of-Service (HMO-POS) plan.
How Medicare SNPs work.
Medicare 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.
Like all Medicare Advantage plans, these plans must cover the same benefits as Original Medicare, Part A, and Part B, with the exception of the hospice benefit (which is still covered under Original Medicare). Medicare Advantage Special Needs Plans may also include coverage beyond Part A and Part B, such as routine vision and dental, hearing services, or wellness programs. Unlike other types of Medicare Advantage plans that may or may not cover prescription drugs, these plans always include prescription drug coverage.
Out of network coverage: Can I get my health care from any doctor, other health care provider, or hospital?
Generally, you must get your care and services from doctors or hospitals in the Medicare SNP network, except:
• Emergency or urgent care, like the care you get for a sudden illness or injury that needs medical care right away.
• If you have End-Stage Renal Disease (ESRD) and need out-of-area dialysis.
Medicare SNPs typically have specialists in the diseases or conditions that affect their members.
Insurance companies that offer special needs plans (SNPs) in Arizona
Individuals covered by both Medicare and Medicaid. Commonly referred to as “dual eligible members,”
Enrolling in specialized Medicare plans allows dual eligible members to receive all of their health care services, including prescription drug benefits, from a single, integrated health plan
Medicare Advantage Dual Special Needs Plans (D-SNPs) affiliated with its partner AHCCCS Complete Care (ACC) Medicaid health plan.
2019 D-SNPs Available to AHCCCS (Medicaid) Complete Care (ACC) and RBHA Dual Eligible Members
Available D-SNPs Company: Arizona Complete Care Medicare Advantage (Allwell) for Arizona Complete Care – Complete Care Plan
Counties Available: Cochise, Gila (ACC Only), Graham, Greenlee, La Paz, Maricopa (ACC Only), Pima, Pinal, Santa Cruz, and Yuma
Contact: Allwell from Arizona Complete Health
Allwell from Arizona Complete Health
PO Box 10420
Van Nuys, CA 91410
• 1-800-977-7522; (TTY: 711)
• From October 1 – March 31, you can call us 7 days a week from 8 a.m. to 8 p.m.
From April 1 – September 30, you can call us Monday – Friday from 8 a.m. to 8 p.m.
A messaging system is used after hours, weekends, and on federal holidays.
Available D-SNPs Company: Banner – University Care Advantage for Banner – University Family Care
Counties Available: Cochise, Gila, Graham, Greenlee, La Paz, Maricopa, Pima, Pinal, Santa Cruz, and Yuma
Contact: Banner – University Care Advantage (HMO SNP)
Customer Care Center
8 a.m. to 8 p.m., 7 days a week
Available D-SNPs Company: ONECare by Care1st Health Plan of Arizona (WellCare Liberty) for Care1st Health Plan of Arizona
Counties Available: Apache, Coconino, Gila, Maricopa, Mohave, Navajo, Pinal, and Yavapai
Contact: Company Headquarters
8725 Henderson Road Tampa, FL 33634
WellCare Medicare – Duals/SNP Plans
Current members: 1-877-778-1855
Prospective Members: 1-866-527-0056
Monday-Sunday, 8 a.m. to 8 p.m.
Available D-SNPs Company: Mercy Care Advantage for Mercy Care
Counties Available: Gila (ACC Only), Maricopa, and Pinal (ACC Only)
Contact: Mercy Care
7 a.m. to 6 p.m. Monday through Friday
602-263-3000 or 1-800-624-3879
Hearing Impaired (TTY/TDD 711)
Mercy Care Advantage
8 a.m. – 8 p.m., 7 days a week
602-586-1730 or 1-877-436-5288
Hearing Impaired (TTY/TDD 711)
Mercy Care /Mercy Care Advantage
4755 S. 44th Place
Phoenix, Arizona 8504
Available D-SNPs Company: Steward Health Choice Generations for Steward Health Choice of Arizona
Counties Available: Apache, Coconino, Gila, Maricopa (ACC Only), Mohave, Navajo, Pinal (ACC Only), and Yavapai
Contact: Steward Health Choice Generations
410 N. 44th Street, Ste. 510
Phoenix, AZ 85008
Dental Prior AUTH – Ste. 520
General Correspondence – Ste. 900
HCG Claims – Ste. 510
Fax: (Pima County) : 520-322-5784
Available D-SNPs Company: UnitedHealthcare Community Plan Dual Complete for UnitedHealthcare Community Plan
Counties Available: Maricopa, Pima, Gila and Pinal
Contact For Information about Medicare Advantage plans you
1-800-905-8671 TTY: 711
8 a.m. to 8 p.m. local time, 7 days a week
Contact UnitedHealthcare by phone, online or by mail.
Call the number on the back of your member ID card.
Hours of operation: 8 a.m.–8 p.m. local time, 7 days a week
UnitedHealthcare Customer Service
PO Box 29675
Hot Springs, AR 71903-9802
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