What are Medicare Special Needs Plans (SNPs)?

Special Needs Plans (SNPs) are a kind of Medicare Advantage plan for beneficiaries who meet certain eligibility criteria. Like other kinds of Medicare Advantage plans, these plans are available through Medicare contracted private insurance companies.

Eligibility for Special Needs Plans

To enroll in a Medicare Special Needs Plan, you would need to fulfill the following eligibility requirements:

 

• You’ve got Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance)
• Live in the area of coverage in the Special Needs Plan.
• Meet the eligibility requirements that the Special Needs Plan targets (i.e., sleep in an institution; have Medicare and Medicaid; or have the chronic condition(s) that the plan targets).

What are the Three Types of Medicare Special Needs Plans?

Chronic-Condition Special Needs Plans (C SNP) are for beneficiaries whith severe or disabling chronic health conditions. There are conditions approved by the Centers of Medicare & Medicaid Services (CMS).You can join a Medicare SNP if you meet these  requirements:

 

If you do meet the plan’s eligibility requirements, like among one of these: you will be got one or more of these severe or disabling chronic conditions:

• Chronic alcohol and other dependence Autoimmune disorders
• Chronic Heart Failure
• Cancer (Excluding pre-cancer conditions)
• Cardiovascular disorders
• Chronic cardiopathy
• Dementia (DM)
• End-Stage Renal Disease (ESRD)
• Severe hematologic disorders
• HIV/AIDS
• Chronic lung disordres and disabling mental state conditions
• Neuroligic disorders
• Stroke 
• Diabetes Mellitus
• You reside in an institution (like a nursing home), otherwise you need treatment reception.

Chronic-Condition Special Needs Plans (C SNPs) may include provider networks with physicians and hospitals that consider treating the precise condition of its members, or the’ll have formularies that are tailored to include the parmaceuticals that treat that illness.

 

Institutional Special Needs Plans (I SNPs) are for beneficiaries who live or are expected to live in an institution or require medical aid in their home for 90 days or more. This includes assisted living or nursing homes, long-term care skilled nursing facilities, inpatient psychiatric facilities, or intermediate care facilities for people with developmental disabilities. Enrollment of a special needs individual on the premise of the potential for a 90-day stay must be supported a CMS-approved assessment.

 

Dual Eligible SNP are for beneficiaries who have both Medicare and Medicaid, also called dual eligibles. 

What are my copayments like in a Medicare SNP?

If you have Medicare and Medicaid, most of the costs of joining a Medicare SNP are covered for you. Contact your Medicaid office for more information and figure out if you qualify for Medicaid benefits.

 

If you are do not have both Medicare and Medicaid (or get other help from your state paying your Medicare premiums), your exact costs will vary on the plan you opt in. In general, you’ll pay the basic costs of getting a Medicare Advantage plan.

Medicare Advantage Special Needs Plans benefits

There are some extra benefits in getting a SNP Plan which include:

 

• Lower co-pays for medications
• Eye exams and lenses benefits
• Hearing exams and Hearing devices benefits
• Transportation benefit to go to the pharmacy or clinic
• Over-The-Counter credit to buy health-related products
• Dental care benefits with a higher dollar amount compared to a regular Medicare Advantage Plan
• Wellness Programs like free memberships to the gym

If you are enrolled in a Special Needs Plan for dual eligibles, there’s also certain social services available to help coordinate your Medicare and Medicaid benefits. 

 

It’s important to note that you still get all the coverage that’s otherwise included with Original Medicare, Part A and Part B, and Medicare Part D. 

 

The Special Needs Plan simply offers more coverage to help you better manage your particular situation.

 

One key difference between a Special Needs Plan and differant kinds of Medicare Advantage plans is that each (SNP) must cover prescription drugs. In contrast, other Medicare Advantage plans (for example, HMOs and PPOs) may or may not include Prescription Drug Coverage.

Getting Help with Medicare Special Needs Plans Costs

If you have both Medicare and Medicaid or if you have limited income, Medicaid is able to cover some or all of your Medicare Advantage Special Needs Plan’s premiums and out-of-pocket costs. Depending on your income levels…you’ll qualify for a Medicare Savings Program, which can help get into a special needs plan and buy costs like premiums, copayments, coinsurance, or deductibles.

How to Apply for a Medicare Savings Program?

Once you know which benefits you may be eligible for, go to the Social Secuity Medicare Benefits page to apply online. 

You may also call your State Medicare Program to see if you qualify and to apply. If you reside in the state of Texas, go to www.yourtexasbenefits.com to apply online.

You can also apply in person at a benefits office or location. Call 2-1-1 to find one near you. 

Finally, there are some licensed insurance agents that help seniors fill out these applicaitons for you.

I am one of them :).

If you need help finding out if you qualify for Extra Help or a Medicare Savings Program…Please contact me to:

1. A) Help you apply for a Medicare Savings Program

1. B) Guide you on what to do or where to go to apply for one

1. C) Keep you updated on your Medicare Savings Program status

1. D) Answer any questions you may have. I am just a phone call away.

Need Help?

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