Special Needs Plans (SNPs)
A Special Needs plan is a type of Medicare advantage plan that caters to people with certain conditions, in certain situations, or who also have state Medicaid. SNP, for short, these plans include care coordination services. They tailor their benefits, provider choices, and a list of covered drugs two best week the specific needs of the groups of people they serve. Like traditional Medicare advantage plans, these SNP plans can be either HMO or PPO plan types. There are three types of special-needs plans: dual eligible, chronic condition, and institutional. You can join the plan if you have both Medicare Part A and Part B, you live in the plans service area, and you meet the eligibility requirements for the plan.
Dual Eligible SNP (D-SNP)
The most popular type of SNP is the D-SNP! Dual eligible plans are for beneficiaries of both Medicare and Medicaid. Medicare being federal and Medicaid offered by the state. The states helps in covering some of the individuals out of pocket costs, in some cases all. The amount covered will depend on the level of Medicaid. A D-SNP combines multiple coverages and coordinates Medicare and Medicaid benefits to make them easy to access for people who have both. States decide which D-SNPs health plans can offer and may review the specific benefits provided.
Medicaid offers additional coverage to a limited population meeting certain criteria:
low income
certain medical conditions
unique health care requirements
Since members who qualify often have the greatest needs, D-SNPs tend to offer the most in-depth set of health benefits among all Medicare plans. D-SNPs often offer extra benefits beyond what you can get from original Medicare and Medicaid. These benefits can fill gaps in your care and improve your quality of life. Some may include: dental coverage, gym memberships, eyeglasses, hearing aids, allowances for food and over-the-counter products or even gasoline, transportations assistance, meal delivery, a personal care team.
Chronic Condition SNP (C-SNP)
The C-SNP is not quite as common as a D-SNP, but they are growing in popularity. A Chonic Condition Special Needs plan is designed for people who need extra support due to an eligible chronic or disabling condition. All C-SNP plans, like other Medicare Advantage plans in include the Part A and Part B benefits. All Special Needs Plans also include prescription drug coverage. What qualifies as a chronic condition? Common qualifying conditions include diabetes, chronic cardiovascular conditions, and chronic respiratory disorders. We spoke with a client just this week who is currently on a C-SNP for diabetes. He was interested in options for plans with a different company, and after reviewing the options leaving the C-SNP for a regular Advantage would raise his prescription costs almost $2,000 over the course of the year.
Institutional SNP (I-SNP)
The I-SNP is for those needing the level of care a facility offers living (or are expected to live) for at least 90 days straight in a facility like a: nursing home, psychiatric hospital, rehabilitation hospital, long-term care hospital, and other facilities that offer similar long-term health care services. If you have an I-SNP, you will get all or most of the medical and support services you require in one place. This eliminates the need to travel for preventive care, such as vaccinations and mammograms. It also reduces the need for stressful and disruptive emergency room visits and hospital stays. The Centers for Medicare and Medicaid Services (CMS) requires I-SNPs to produce a detailed Model of Care (MOC) to outline how the facility will meet your medical needs. The costs for an I-SNP vary from plan to plan, just like they do for any Medicare Advantage plan. It is important to consider all features before signing up for a plan.
Conclusion
If you think you or a loved one may qualify and benefit from one of the special needs plans listed above, give us a call or fill out the form on our ‘contact’ page as we would love to help qualify and guide you towards the next steps.