Tailored medical care is crucial for addressing unique health circumstances. With this principle in mind, Medicare Special Needs Plans (SNPs) were developed.
These plans are Advantage Plans, specifically designed to cater to individuals with specific health conditions or situations.
Each SNP is crafted to address the patient’s particular needs, shaping its network, benefits, and drug formulary accordingly. The focus is on providing comprehensive support tailored to the patient’s condition. Many of these plans go further by assigning care coordinators. These coordinators are pivotal in aiding patients with condition management, adherence to physician recommendations, access to community resources, and ensuring timely prescription refills.
Eligibility for a Special Needs Plan due to chronic illness is determined by diagnosis of one or more qualifying conditions, including:
However, the availability of chronic illness SNPs can vary by location as insurance companies decide where to offer specific plan designs. This means not all patients with chronic conditions may find a plan tailored to their needs in their area. Furthermore, relocating to a different coverage area impacts eligibility. Seeking guidance from a licensed insurance professional can be beneficial in navigating these plans and finding suitable options.
Aside from chronic illness SNPs, there exist other categories like Institutional SNPs and Dual-Eligible SNPs. Institutional SNPs are designed to serve individuals anticipated to reside in institutional settings for over 90 days, offering integrated healthcare for those no longer capable of independent living.
Special Needs Plans for Dual Eligibles, commonly known as DSNPs, cater to individuals who qualify for Medicare and Medicaid. Medicaid often covers premiums and a significant portion of co-pays and deductibles.
DSNPs offer a range of benefits, including:
Enrollment in a DSNP depends on the geographical area, and individuals must maintain their enrollment in Original Medicare. Part B premiums are typically paid to Social Security unless Medicaid covers them. Additionally, DSNPs charge separate premiums, and patients are responsible for co-pays and deductibles outlined by the plan.
Individuals who become eligible for a DSNP any time during the year qualify for a Special Enrollment Period, allowing them to select a suitable plan.
This video tutorial covers the basic elements of Medicare in a format that is easy to understand and you can watch it from the comfort of home! It’s yours at no cost and no obligation, just tell us where we should send it!
"*" indicates required fields
By submitting this information, you acknowledge a
licensed insurance agent may contact you by phone,
email, or mail to discuss Medicare Advantage Plans,
Medicare Supplement Insurance, or Prescription Drug Plans.
Friendly, licensed professionals are available to answer all of your questions. Call (505) 859-3114 or complete the form below and we’d be happy to reach out to you.
Given the complexity of Medicare and the multitude of available plans, it’s common to feel overwhelmed and uncertain. Engaging with an independent health insurance broker can provide clarity and guidance in navigating through the various options.
Medicare has neither reviewed nor endorsed this information.
Not connected with or endorsed by the United States government or the federal Medicare program.
We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all your options.
