Medicare Special Needs Plans (SNPs) are part of the Medicare Advantage plan family and are intended to serve Medicare beneficiaries who have special needs. There are three types of Medicare Special Needs Plans. They include the Chronic-Condition Special Needs Plan, the Dual-Eligible Special Needs Plan, and the Institutional Special Needs Plan. Each plan has its own benefits and may vary slightly from one plan to the next.
Dual-Eligible SNP Plan (D-SNP)
The Dual-Eligible Special Needs Plan is for beneficiaries who are both Medicare and Medicaid eligible. This plan provides coverage similar to that of traditional Medicare but offers a larger network of providers. You may also be eligible for a federal subsidy program called Extra Help.
In order to qualify for D-SNPs, you must qualify for both Medicare and Medicaid. If you meet these requirements, you’ll be able to join a D-SNP that’s available in your area during a Medicare enrollment period.
You can also join a D-SNP during a Special Enrollment Period (SEP). These are enrollment periods granted by Medicare for special reasons, such as moving out of a plan’s service area.
When you enroll in a D-SNP, you must live in the area where the insurance company serves. This is important because you may have trouble finding a provider that accepts both Medicare and Medicaid.
In order to help people enroll in a D-SNP, your marketing materials must include cost-sharing information. You’ll also need to include a disclaimer. You must also include information about the Extra Help level. This is a benefit you get if you’re on a low income.
To make the most of a D-SNP, you’ll need to work with your local community. It’s also important to research the providers in your area. You’ll also need to verify the plan’s coverage and information.
Chronic Illness SNP Plan (C-SNP)
Medicare C-SNP plans are health insurance plans that offer specialized care for patients with a specific chronic condition. They are designed to help individuals avoid hospitalization and to better manage their health conditions. Generally, these plans include regular dental care, hearing care, vision care, and drug coverage. In some cases, they may also include extra services like wellness programs and substance abuse counseling.
If you’re interested in enrolling in a Medicare C-SNP plan, you’ll want to contact the plan or an agent. They’ll help you determine whether you qualify. Some will even provide you with a care coordinator. These coordinators work with you and your doctor to ensure you get the health care you need.
In order to qualify, the plan requires that you have a doctor’s confirmation of the condition. You may also be required to have a referral to a specialist in the plan’s network. In some cases, you’ll have to fill out a Chronic Condition Verification Form. If you do not qualify, you’ll be disenrolled from the plan.
If you are disenrolled, you’ll be given a Special Election Period, which allows you to enroll in another Medicare Advantage plan. You’ll also have a two-month grace period after coverage ends. After that, you’ll need to decide whether to re-enroll in the plan or switch to another plan.
You’ll also need to have your prescription drug coverage. In many cases, C-SNPs offer $0 Rx copays for formulary drugs. Some plans also offer extra screenings, nutritional training, and extra monitoring. Some also offer a personalized prescription benefit.
If you qualify for a Medicare C-SNP plan, your medical provider will work with your doctor and care coordinator to create a plan for your specific health condition. You may also receive a Humana Healthy Options allowance for healthy food.
Institutional SNP Plan (I-SNP)
Institutional Special Needs plans (I-SNPs), are SNPs that limit enrollment to MA-eligible people who have or are expected to require the same level of services in long-term (LTC) skilled nursing facility, (NF), an LTC nurse facility (NF), an SNF/NF or intermediate care facility for individuals living with intellectual disabilities (ICF/IDD), as well as an inpatient psychiatric hospital.
SNP Costs
Depending on where you live, the costs of Medicare Special Needs Plans may vary. The best way to learn about the various plans is to speak with a licensed insurance agent. They can provide you with all the information you need to compare plans.
While it’s impossible to say for sure, a Special Needs Plan may have zero premiums. In fact, the average member-weighted monthly benefit is $180. It may also include other benefits that you may not be aware of.
Nonmedical services offered by Medicare Special Needs Plans
Medicare special needs plans are supplemental benefits offered by Medicare Advantage plans that are primarily designed for people with chronic conditions. Some experts believe that these benefits help improve the health of beneficiaries.
Nonmedical services include transportation, meals, social services, and home modifications. These services are not offered by all Medicare Advantage plans. These services may address social circumstances that affect health, such as food insecurity. Some experts also believe that these services can help reduce hospitalizations due to congestive heart failure.
More Medicare Advantage plans are offering home-delivered meals. These meals may help reduce hospitalizations for congestive heart failure. However, less than ten percent of dual-eligible beneficiaries had plans that offered these services.
The number of plans on the market increased 14% between 2020 and 2021. Researchers analyzed public Medicare Advantage benefit package data from 2021 to determine the prevalence of these benefits.
Researchers interviewed directors of care management, clinical affairs, and quality and regulatory affairs. The study also analyzed the relationship between premiums and plan offerings. The research found that Medicare Advantage plans that enrolled dual eligible beneficiaries offered more nonmedical supplemental benefits than general MA plans. The researchers noted that the supplemental benefits offered by general MA plans included vision, hearing, dental, gym memberships, and debit cards for over-the-counter medications.
Preexisting conditions limitation on medicare special needs plans
Using a Medicare Supplement plan to manage your chronic medical condition can be a costly exercise. If you have a chronic condition and are unable to afford health care, consider a Medicare Special Needs Plan (SNP) to help alleviate the pain. An SNP is a Medicare Advantage plan that provides your benefits through a network of providers. Depending on your state, your coverage may span the entire state, or you may be restricted to one county. You can find out if an SNP is available in your area by visiting Medicare’s website and browsing their online database of local Medicare providers. Having a good idea of what your coverage options are can save you money.
The Medicare Supplement and SNP have their pros and cons, but if you want the best coverage at the best price, you should shop around. If you are under 65, you may be able to enroll in Medicare Parts A and B before you turn 65. In addition to a Medicare Supplement and SNP, you may also qualify for other forms of Medicare such as a Medicare Advantage plan or Medicare prescription drug plan (PDP). The Medicare website also provides a Medicare Plan finder to help you find the right plan for you. The Medicare website also provides the latest Medicare news and updates, including information on new plans and Medicare policy changes.