If you’re a Medicare Advantage beneficiary with a chronic illness or disability, you may have heard about Special Needs Plans (SNPs). These plans are designed to provide targeted, comprehensive care for people with specific health needs. In this blog post, we’ll cover everything you need to know about Medicare Advantage SNPs, including how they work, who is eligible, and the benefits they offer.
What is a Medicare Advantage Special Needs Plan?
A Medicare Advantage Special Needs Plan (SNP) is a type of Medicare Advantage plan that is designed to provide targeted care for people with specific health needs. There are three types of SNPs:
- Chronic Condition Special Needs Plan (C-SNP): This type of plan is designed for people with chronic illnesses such as diabetes, heart disease, chronic obstructive pulmonary disease, cardiovascular disease, and end-stage renal disease.
- Dual Eligible Special Needs Plan (D-SNP): This type of plan is for people who are eligible for both Medicare and Medicaid.
- Institutional SNP (I-SNP): This type of plan is designed for people who live in an institution, such as a nursing home or assisted living facility.
Who is Eligible for a Medicare Advantage Special Needs Plan?
To be eligible for a Medicare Advantage SNP, you must meet certain criteria. For example, if you’re enrolling in a Chronic Condition SNP, you must have the specific chronic condition that the plan is designed for. If you’re enrolling in a Dual Eligible SNP, you must be eligible for both Medicare and Medicaid. Additionally, you must live in the plan’s service area.
Benefits of a Medicare Advantage Special Needs Plan
Medicare Advantage SNPs offer a range of benefits that are tailored to the specific health needs of the plan’s members. These benefits may include:
- Prescription Drug Coverage: All Medicare Advantage SNPs must offer prescription drug coverage. This coverage may include both brand-name and generic drugs.
- Coordinated Care: Medicare Advantage SNPs have a team of healthcare providers who work together to provide coordinated care. This can help prevent medical errors and ensure that you’re getting the care you need.
- Specialized Providers: Medicare Advantage SNPs often have a network of specialized providers who have experience treating the specific health needs of the plan’s members.
- Transportation: Some Medicare Advantage SNPs offer transportation services to help members get to and from medical appointments.
- Fitness Programs: Many Medicare Advantage SNPs offer fitness programs and wellness activities to help members stay healthy.
How to Enroll in a Medicare Advantage Special Needs Plan
Enrolling in a Medicare Advantage SNP is similar to enrolling in any other Medicare Advantage plan. You can enroll during the Initial Election Coverage Period which is the same period as your IEP (7-month window when you are first eligible for Medicare coverage) and this period becomes effective after your Part B does.
Also, you can use the Annual Enrollment Period (AEP), which runs from October 15 to December 7 each year. You can also enroll in a Medicare Advantage SNP during a Special Enrollment Period (SEP) if you experience a qualifying event, such as moving to a new area or losing your current coverage.
To enroll in a Medicare Advantage SNP, you’ll need to provide some basic information about yourself, such as your name, address, and Medicare number. You’ll also need to choose a plan that meets your specific health needs.
Drawbacks of Medicare Advantage Special Needs Plan
Despite the potential benefits, there are several drawbacks associated with SNPs that must be taken into consideration:
- Access limitations: The availability of certain SNPs may vary depending on the geographic location. Moreover, if you require medical attention while traveling outside of your state of residence, your coverage options may be limited.
- Restricted choice of providers: Opting for an SNP means that you will have to select a provider network determined by the insurance provider. This could mean that your preferred doctor may not be included in the network, thereby reducing your choices.
- Referral and preapproval requirements: You will need a referral from your primary care physician to see a specialist, and some plans may require preapproval from the insurance company.
Special Needs Plans Costs
In the event that you are a recipient of both Medicare and Medicaid, most of the expenses that come with enrolling in a Medicare Special Needs Plan (SNP) will be covered for you. To learn more and determine if you are eligible for Medicaid benefits, contact your State Medical Assistance (Medicaid) office. However, if you don’t have both Medicare and Medicaid (or any other form of assistance from your state that pays for your Medicare premiums) and you choose to enroll in a Medicare SNP, your actual costs will differ depending on the particular plan you select. Generally, the following expenses will apply:
- Your monthly Medicare Part B premium
- Any additional monthly premium that the Medicare SNP imposes beyond the Medicare Part B premium for Medicare Part A and Part B services
- Any extra monthly premium that the Medicare SNP imposes for prescription drug benefits
- Any extra monthly premium that the Medicare SNP imposes for additional benefits
- Any deductible, coinsurance, or copayment amount that the Medicare SNP imposes, such as a fixed copayment amount each time you visit a doctor
Your costs will also hinge on the type and frequency of healthcare services you require, your adherence to the plan’s guidelines, and the amount the plan charges for any additional benefits you may need. If you’re eligible for both Medicare and Medicaid, the SNP cannot impose cost-sharing amounts that are higher than what you would pay in Original Medicare or Medicaid. Prior to enrolling, get in touch with experienced Medicare insurance agents who can help you compare your plans and get an informed decision based on your specific budget and needs.
SNP Key Takeaways
- Medicare Advantage Special Needs Plans (SNPs) are designed to provide targeted care for people with specific health needs.
- There are three types of SNPs: Chronic Condition SNPs, Dual Eligible SNPs, and Institutional SNPs.
- Eligibility for an SNP depends on meeting certain criteria, such as having a specific chronic condition or being eligible for both Medicare and Medicaid.
- SNPs offer benefits tailored to members’ specific health needs, such as prescription drug coverage, coordinated care, specialized providers, transportation, and fitness programs.
- Enrolling in an SNP is similar to enrolling in any other Medicare Advantage plan, and can be done during the Initial Election Coverage Period, Annual Enrollment Period, or Special Enrollment Period.
- Drawbacks of SNPs include access limitations, restricted choice of providers, referral and preapproval requirements, and varying costs depending on the plan.
- If you are eligible for both Medicare and Medicaid, most of the expenses that come with enrolling in an SNP will be covered for you.