Understanding the Basics of Special Needs Plans in Medicare - Three Types
If you think a Medicare Advantage Special Needs Plan is the right choice for you, we're here to help. It's not always easy to determine which plan will best suit your health care needs, especially when applying for the federal Medicare program from the United States government.
Medicare SNPs (Special Needs Plans) can be particularly difficult to navigate. We’ll break it down so you can understand the three types of Medicare SNPs and precisely what they cover.
You can also check out the federal government website at Medicare.gov to learn more information about Medicare Advantage Plans, like an HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), or C-SNP (Chronic Special Needs Plan), to name a few.
About Special Needs Plans
Special Needs Plans offer unique coverage, but they have enrollment eligibility requirements. The best benefit of enrolling in one of these affordable Medicare plans is the specialized care and benefits you’ll receive that will help you meet your health care needs.
Medicare beneficiaries of SNPs also must receive health care from providers that are inside the SNP care network. The only exceptions are for emergency situations, like if you require urgent care or need dialysis.
The three kinds of Special Needs Plans all have different eligibility requirements. The available coverage options are Chronic Condition Special Needs Plan (C-SNPs), Institutional Special Needs Plan (I-SNP), and Dual-Eligible Special Needs Plan (D-SNP).
Can I Get a Special Needs Plan?
You can apply for Medicare Special Needs Plans if you meet certain criteria, including:
- Medicare Part A and Part B enrollment eligibility
- A primary residence in the plan's service area
- Eligibility according to the requirements of your specific plan
Enrollment requirements for a Medicare Advantage Special Needs Plan include having chronic, severe, or disabling medical conditions or developing a sudden illness that meets qualifying criteria. If you were to become sick outside of the Annual Enrollment Period, you could still enroll under the Special Election Period.
You can also get a Special Needs Plan if you live in a long-term care institution, like a skilled nursing facility, or if you have eligibility for both Medicare and Medicaid benefits.
Three Types of Special Needs Plans
As stated above, the three different Special Needs Medicare Advantage Plans are Dual-Eligible SNP (D-SNP), Chronic Condition SNP (C-SNP), and Institutional SNP (I-SNP). Below, we'll give you a summary of these three types of Special Needs Plans and what the eligibility requirements are for each one.
One thing these three plans have in common is that they all require a primary care physician. The doctor you choose will be your main health care provider. They’ll act as a care coordinator, managing all your care in the Medicare SNP network in your service area.
A Special Needs Plan is much more convenient than the original Medicare plan or the standard Medicaid services because you don’t have to sign up for different plans to get coverage and benefits for all the health care services you need. An example is coverage for prescription drugs, which is usually under Medicare Part D.
D-SNPs: Dual Special Needs Plan
To enroll in a Dual Special Needs Plan (D-SNP), you must have both Medicare and Medicaid eligibility. Most D-SNPs also offer prescription drug coverage and other benefits, usually at no extra cost depending on what Medicare plan you have.
C-SNPs: Chronic Special Needs Plan
Chronic Special Needs Plans (C-SNPs) are for people with severe, disabling, or chronic conditions, like end-stage renal disease, diabetes mellitus, or autoimmune disorders like HIV/AIDs. Since many private insurance companies will deny coverage if you have certain chronic conditions, C-SNPs are a practical choice for many people.
I-SNPs: Institutional Special Needs Plan
Institutional Special Needs Plans (I-SNPs)are for people who live in a medical institution, like a nursing home or an inpatient mental health facility. Those who need at-home nursing care are also eligible for this plan.
At this time, Alignment Health Plan does not offer I-SNPs.
How Medicare SNPs Work
Medicare SNPs work by offering specialized coverage and medical care for those who meet certain eligibility requirements. Remember that D-SNPs are for those who are eligible for both Medicare and Medicaid, I-SNPs are for those living in a long-term care facility, and C-SNPs are for those with severe or disabling health conditions.
That's why a Medicare Advantage Plan is so convenient. It provides all the health insurance you need under one umbrella plan (depending on your eligibility). Also, please keep in mind that health care coverage also varies based on the insurance company that you choose to carry your Special Needs Plan.
Frequently Asked Questions About Special Needs Plans
What Are Dual Special Needs Plans (D-SNP)?
A D-SNP is for people who have dual coverage from both Medicare and Medicaid. This plan provides the same coverage range as original Medicare, and your particular state will determine any extra benefits you might get.
What Is a Chronic Special Needs Plan (C-SNP)?
A Chronic Special Needs Plan is for people with chronic or severe medical conditions, such as neurological diseases or HIV/AIDS. This plan helps coordinate care and gives extra coverage for specific health conditions that weren’t part of original Medicare, including access to specialists or condition-specific wellness programs. Be sure to review the plan’s qualification criteria to understand which chronic conditions that it covers.
How Do SNP Plans Work?
Medicare SNPs work by offering specialized coverage for those with certain qualifying conditions, like a chronic illness, or those who live in a nursing home. Medicare SNPs are ideal for people who can't get the coverage they need through Medicare Part A and B because of their unique health conditions. Instead, they can opt for Medicare SNPs tailor-made for their particular healthcare needs.
Read More: Additional Medicare Advantage FAQs
If you're looking for comprehensive health care, then a Medicare Advantage Special Needs Plan might be the right choice for you. Check out your options here at Alignment Health Plan or speak to one of our licensed insurance agents today to find the right Special Needs Plan for you.
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