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What Is a Medicare Special Needs Plan?

Medicare Special Needs Plans, or SNPs, are a type of Medicare Advantage plan that tailors its benefits to a specific group of people. They can be quite helpful in making sure those groups get the care they need to maintain or improve their current condition. Within this subset of Medicare Advantage plans, there are three types of SNPs. Let’s take a look at each type today.

Dual-Eligible Special Needs Plans

Abbreviated as either D-SNP or DE-SNP plans, this option is for Medicare beneficiaries who are “dual-eligible” for both Medicare and Medicaid. Medicaid is a national federal program that is distributed and regulated by each individual state. States set their own eligibility requirements, but generally speaking, you must have limited income and resources to apply.

If you’re already enrolled in Medicaid, you’ll need to apply for a Medicare Savings Program when you become eligible for Medicare. There are four main savings programs.

  1. Qualified Medicare Beneficiary (QMB)
  2. Specified Low-Income Medicare Beneficiary without other Medicaid (SLMB)
  3. Qualifying Individual (QI)
  4. Qualified Disabled and Working Individual (QDWI)

Insurance carriers who offer D-SNP plans may allow enrollment for all levels of the Medicare Savings Program or have more limited options. While every plan is different, most have$0 premiums and $0 cost-sharing as long as the beneficiary seeks care from a contracted provider. Like other kinds of Medicare Advantage plans, there are often many extra benefits included.

Individuals who qualify for a D-SNP plan have the opportunity to change their plan during the first three quarters of the year. If they lose their Medicaid eligibility at any time, they’ll need to enroll in a different kind of Medicare Advantage plan.

Chronic Condition Special Needs Plans

As their name implies, C-SNPs are for Medicare beneficiaries who have chronic conditions. There are a myriad of conditions that could qualify you for a C-SNP, but just like the D-SNP plans, insurance carriers may only accept certain conditions. Common conditions accepted by many carriers include diabetes and cardiovascular disease. Other conditions include:

  • Autoimmune disorders
  • Cancer
  • Chronic alcohol and other dependence
  • Chronic heart failure (CHF)
  • Chronic lung disorders
  • Chronic and disabling mental health conditions
  • Dementia
  • End-stage liver disease
  • End-Stage Renal Disease (ESRD) requiring dialysis
  • HIV/AIDS
  • Neurologic disorders
  • Severe hematologic disorders
  • Stroke

The great thing about a C-SNP is that the plan tailors the benefits to help beneficiaries treat the condition. If you have a C-SNP because you are a diabetic, the plan will make sure the drug formulary fits your needs; you’ll have access to providers who specialize in diabetes, and you’ll be assigned a care coordinator who’ll help you manage your condition.

You can enroll in a C-SNP plan at any time of the year if you develop a condition that qualifies you. If your condition is cured, you’ll need to choose another Medicare Advantage plan.

Institutional Special Needs Plans

The last type of Special Needs Plan is called an I-SNP. Medicare beneficiaries who need to reside in an institution for at least 90 days and need the level of care found in a long-term care, skilled nursing facility, psychiatric facility, or an intermediate care center (for intellectual disabilities) can enroll in an I-SNP if one is available to them.

Anyone living in an approved Medical institution will receive more immediate and direct attention. There will be no need to keep track of doctors and appointments as the facility will coordinate all care.

As with the other two kinds of SNPs, you can enroll (or disenroll) if your needs change throughout the year.

Not everyone has access to Special Needs Plans. In addition to meeting the criteria to enroll, you must also live in a service area that has an SNP as an option. Each carrier has their own set of requirements, so you may need help determining if you’re eligible. To do so, chat with one of our independent insurance agents at Local Medicare Specialists. We’ll take the time to learn about your unique situation and then find a plan that fits those needs.

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