Should You Get A Medicare Snp
Medicare SNPs are designed specifically for those who have chronic illnesses, are covered by both Medicare and Medicaid, or who are institutionalized. In addition to providing the same coverage that Original Medicare Parts A and B provide, they also meet the specific needs of those who qualify for their targeted coverage. Where you are likely to find yourself underserved, overwhelmed, and frustrated within the parameters of a standard, generic Medicare Advantage plan, SNPs are tailored to your likely treatments, medications, and care coordination needs if you meet eligibility criteria.
Related Articles
When Can I Enroll In A C
If you meet the eligibility requirements for a C-SNP, you can enroll at any time. This is known as a Special Enrollment Period. If you are newly diagnosed or have a worsening condition that makes you eligible for a C-SNP, you dont have to wait for specific Medicare enrollment periods to join a plan.
If you prefer, you can also enroll for a C-SNP during these timeframes:
Initial Enrollment Period: If you are newly qualified for Medicare due to age, initial enrollment begins three months before your 65th birthday and ends three months after your 65th birthday, for a total of seven months .
If you are newly qualified for Medicare due to disability, initial enrollment begins three months before the 25th month you receive either Social Security or Railroad Retirement Board disability benefits and lasts for seven months.
Annual Election Period: Your Annual Election Period takes place each year from Oct. 15 to Dec. 7. During this period, you can switch from an existing plan or enroll in a C-SNP for the first time. You can also disenroll from your plan during this time.
Snps Are Required To Provide Part D Drug Coverage
âThe advantage to the Special Needs plan, if you meet the criteria, is that it typically includes the same benefits as a Medicare Part D prescription drug plan, which can help defray the costs of ongoing prescription medication,â Nance says.
In fact, according to the Centers for Medicare and Medicaid Services , SNPs are required to provide Part D benefits âbecause special needs individuals must have access to prescription drugs to manage and control their special health care needs.â
Read Also: Can I Use Medicare For Dental
***new*** Request For Information For Chronic Condition Special Needs Plans
CMS has released a Request for Information seeking input from the public on the review and updating of the list of special needs plan specific chronic conditions by a panel of clinical advisors to be held during the fall of 2019. Comments will be used to inform the panels review and update of the current list of qualifying chronic conditions. Responses to the RFI will be accepted from . A link to the RFI can be found at the bottom of this webpage in the Downloads section.
C-SNPs are SNPs that restrict enrollment to special needs individuals with specific severe or disabling chronic conditions, defined in 42 CFR 422.2. Approximately two-thirds of Medicare enrollees have multiple chronic conditions requiring coordination of care among primary providers, medical and mental health specialists, inpatient and outpatient facilities, and extensive ancillary services related to diagnostic testing and therapeutic management.
Heres How To Apply For An Snp
If you think you qualify for an SNP, you first need to get a note from your doctor detailing your condition. Then, you have to find out if there are SNPs available in your area. An easy way to get started is to contact your local SHIP, or state health insurance assistance program, where you can get free health care counseling and advice. Your counselor can help you find a Medicare Advantage plan thatâs right for you.
Read Also: How To Get Medicare In Ga
How Much Does A Special Needs Plan Cost
Depending on the plan you have, a Special Needs Plan may include some of the following costs:
- Monthly premium
- Copayments or coinsurance
- Additional premiums or deductibles for prescription drug coverage
The costs tied to Special Needs Plans can vary significantly between one area, plan or insurance carrier to the next. Costs can also depend on whether or not you qualify for financial assistance or are eligible for Medicaid.
Read additional medicare costs guides to learn more about Medicare costs and how they will affect you.
Medicare Advantage Special Needs Plans
Home / Part C / Special Needs Plans
Medicare Advantage Special Needs Plans offer tailored plan options to Medicare enrollees with certain health or economic issues. Just as all people have individual medical needs, not all health conditions are generic. You may find your medical needs can be complex, but this doesnt mean your coverage should be too. SNP Medicare plans are available to help simplify your coverage with plans designed for your situation.
Find Medicare Plans in 3 Easy Steps
We can help find the right Medicare plans for you today
Don’t Miss: Is Prolia Covered By Medicare Part B Or Part D
What Are Special Needs Plans Plans
Discover how a Medicare Special Needs Plan might work for you. Medicare offers several types of SNPs, tailored to patients who require ongoing medical treatments or live in a long-term nursing facility. Explore the criteria and benefits of joining a Special Needs Plan through Medicare Advantage.
Navigating healthcare services can be daunting for anyone, especially those requiring extended medical benefits. Medicare Advantage offers Special Needs Plans for dual-eligible beneficiaries on both Medicare and Medicaid, and others experiencing chronic, institutional, or institutional-equivalent special needs.
Medicare Advantage Special Needs Plans : Everything You Need To Know
With Medicare Advantage, beneficiaries use private insurance policies offered by Medicare. Medicare Advantage plans come in four forms: Health maintenance organizations , preferrered provider organizations , private fee-for-service programs, and special needs plans . Medicare Advantage SNPs are specialized for those with chronic conditions. Read on to learn more about SNPs and whether they may be right for you.
Read Also: Is Medicare A Social Security Benefit
Who Should Get A Medicare Snp
A Medicare SNP plan may be a good choice for you if you qualify, and if:
- You have a chronic health condition that requires multiple medications and frequent interventions from healthcare providers. You could benefit from targeted, coordinated care.
- You reside in a facility for at least 90 days because you need care that you cannot receive at home. You may receive additional coverage for skilled nursing services.
- You are eligible for Medicare and Medicaid. Your plan will make sure your providers accept Medicaid and will help coordinate payments.
What Types Of Medical Professionals Manage My Care If I Have An I
I-SNPs rely heavily on the expertise of nurse practitioners. Based upon your medical needs, you will probably meet at least weekly with a nurse practitioner who is familiar with your chart and can make recommendations for your ongoing support. You may also see doctors and therapists, such as mental health professionals and physical therapists.
What extra benefits and savings do you qualify for?
Don’t Miss: Does Medicare Offer Dental And Vision Coverage
Statutory And Regulatory History
The Medicare Modernization Act of 2003 established an MA CCP specifically designed to provide targeted care to individuals with special needs. In the MMA, Congress identified special needs individuals as: 1) institutionalized individuals 2) dual eligibles and/or 3) individuals with severe or disabling chronic conditions, as specified by CMS. MA CCPs established to provide services to these special needs individuals are called Specialized MA plans for Special Needs Individuals, or SNPs. 42 CFR 422.2 defines special needs individuals and specialized MA plans for special needs individuals. SNPs were first offered in 2006. The MMA gave the SNP program the authority to operate until December 31, 2008.
The Medicare, Medicaid, and State Childrens Health Insurance Program Extension Act of 2007 subsequently extended the SNP program from December 31, 2008, to December 31, 2009, but imposed a moratorium that prohibited CMS from approving new SNPs after January 1, 2008. Accordingly, CMS did not accept SNP applications in 2008 for contract year 2009.
We Can Help You Save Money On Your Medicare Costs
Those with limited incomes and resources may be eligible for programs that help lower their Medicare costs.
Extra Help to pay for Medicare Part D prescription costs through the Low Income Subsidy Program that can save you up to $5,000 a year.
Medicare Savings Programs that can save you over $147 a month on your Medicare Part B Premiums and possibly more if you qualify.
MORE COSTS SAVINGSIf you qualify and enroll in these programs, you may also be eligible to join our Florida Blue Medicare HMO D-SNP Plan that offers you more benefits and lowers your deductibles and copays.
How we can help . . . Florida Blue Medicare has a team of dedicated specialists available to explain and apply for these programs.
Recommended Reading: Does Medicare Cover In Home Care For Seniors
Institutional Medicare Special Needs Plan
I-SNPs are for certain seniors living in institutions such as nursing homes. I-SNPs are also for those who need at-home health or nursing care for certain illnesses.
When applying for this type of coverage, youll need to include proof of institutionalization need for at least 90 days. You could be eligible even if youre receiving nursing care in a home instead of at a facility.
Humanas Special Needs Plans Are Currently Available In More Than 28 States
- Humana offers Dual-Eligible Special Needs Plans in the following states: AL, AR, CA, CO, CT, DE, FL, GA, IA, IN, KY, LA, ME, MD, MI, MO, MS, MT, NC, NE, NV, NY, OH, OK, PA, PR, SC, SD, TN, TX, WA, WI, WV, and WY.
- Humana offers Chronic Condition Special Needs Plans in the following states: AR, FL, GA, IA, IL, IN, KS, KY, LA, MO, MS, NV, OH, OK, OR, SC, TX, and VA.
Read Also: When Should I Expect My Medicare Card
Cost Of Special Needs Plans
While SNP costs tend to be higher than original Medicare alone, they are on par with Medicare Advantage plan expenses. Individual providers may set their own rates for SNP premiums and copays however, these costs cannot exceed the providers rates for other Medicare-approved services. Qualifiers for both Medicare and Medicaid can receive help to pay premiums.
Snps Offer Benefits Tailored To Address Your Special Healthcare Needs
SNPs provide helpful guidance and resources to members based on their specific condition or needs. The plan may offer extra benefits tailored to the groups it serves, such as diabetes services, care coordination or other health and wellness programs.
To be eligible for an SNP, you must have Medicare Parts A and B and meet the specific conditions of the SNP.
Depending on the specific plan, benefits may also include coverage for routine dental, vision and hearing care nonemergency transportation to and from medical care fitness programs an over-the-counter medication allowance and more.
Recommended Reading: When Is The Open Enrollment Period For Medicare
Who Can Join A Medicare Special Needs Plan
Not everyone who meets the eligibility requirements for Medicare is eligible for a Special Needs Plan.
To qualify, you must have one of these three characteristics:
- You have a chronic condition such as diabetes, heart disease, or one of 13 other ailments determined by the Centers for Medicare and Medicaid Services.2 You can join a Chronic Condition Special Needs Plan, or C-SNP.
- You have both Medicare and Medicaid. People who meet this qualification are referred to as dual-eligibles and can join plans called Dual Eligible Special Needs Plans, or D-SNPs. Not sure what the difference is? Compare Medicare vs. Medicaid.
- You live in an institution such as a nursing home, or you require that level of care at home. You can join an Institutional Special Needs Plan, or I-SNP.
What Is A C
C-SNP stands for Chronic Condition Special Needs Plan. C-SNPs are a special type of Medicare Advantage plan. Because of the plans targeted care, eligible members typically have medical conditions or characteristics in common. If you have a chronic, long-term health condition such as diabetes, dementia or heart disease, you may benefit from having an insurance plan geared specifically towards your unique needs.
The benefits of having a C-SNP include access to hospitals and medical professionals who specialize in your condition or disease. C-SNPs also use drug formularies geared towards the needs of its membership.
Other benefits may include health and wellness programs, nutrition or substance abuse counseling, or diabetes management services. Like other Medicare Advantage plans, C-SNPs may also include extras that dont specifically pertain to your condition, such as dental and vision coverage.
Some C-SNPs assign you to a care coordinator who provides personal support and oversight of your medical appointments and treatments.
C-SNPs vary in cost as well as coverage. Some plans cost $0 monthly. Others have a monthly premium youre required to pay, in addition to your Part B premium.
Every C-SNP has a network of providers. Your choice of doctors and hospitals can influence out-of-pocket costs, including:
- Deductibles for doctor visits, hospitalization and drug coverage
Find a local Medicare plan that fits your needs
Also Check: What If I Can T Afford Medicare Part B
When Can I Enroll In A Medicare Snp
You may enroll in a Medicare SNP during the annual Medicare Open Enrollment Period that runs from every year.
You may also enroll in a Medicare SNP if you are granted a Special Election Period. You may be given a Special Election Period if:
- You already have Medicare and then develop a chronic health condition
- You move into a nursing home or other long-term care facility
- You move out of your current SNP coverage area
- Your SNP leaves the Medicare program
- You become eligible for Medicaid
Like other types of Medicare Advantage plans, Medicare SNPs will vary in terms of cost, coverage and availability from one location to the next.
List Of Chronic Conditions
Section 1859 of the Act and 42 CFR 422.2 define special needs individuals with severe or disabling chronic conditions as special needs individuals who have one or more co-morbid and medically complex chronic conditions that are substantially disabling or life threatening have a high risk of hospitalization or other significant adverse health outcomes and require specialized delivery systems across domains of care. CMS solicited public comments on chronic conditions meeting the clarified definition and convened the SNP Chronic Condition Panel in the fall of 2008. Panelists included six clinical experts on chronic condition management from three federal agenciesthe Agency for Healthcare Research and Quality , the Centers for Disease Control and Prevention , and CMS. After discussing public comments on a proposed list of SNP-specific chronic conditions, the panelists recommended, and CMS subsequently approved, the following 15 SNP-specific chronic conditions:
Also Check: What’s Better Medicare Or Medicare Advantage
Am I Eligible For A Medicare Special Needs Plan
To be eligible for a Special Needs Plan, you must first be enrolled in Original Medicare and live in the area served by your desired plan.
The additional requirements for each type of SNP plan may also include:
- Chronic Condition SNPs You must have a doctors note confirming you have the health condition addressed by the plan.
- Institutional SNPs You must reside for at least 90 days in a long-term care facility that is served by the plan, or you must meet your states guidelines for needing nursing-level care at home for at least 90 days.
- Dual-Eligible SNPs You must provide your Medicare and Medicaid enrollment verification.
What Is An I
Institutional Special Needs Plans are a type of Medicare Advantage plan. I-SNPs are designed to meet the needs of people living in long-term care settings, such as:
- long-term care nursing facility
- long term care skilled nursing facility
- inpatient psychiatric facility
- intermediate care facility for individuals with developmental delays
To be eligible for an Institutional Special Needs Plan, you must be enrolled in Original Medicare . You must need or will need the level of services provided in an institutionalized setting for 90 days or more. You must also live in the county or local community where the institution you choose is licensed to operate.
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.
Like all Medicare Advantage plans, an I-SNP must cover at least everything Original Medicare does. I-SNPs cover inpatient and outpatient services, including medically necessary treatments and preventive services. You will get medical tests and treatments done on a timely basis, without the stress of keeping track of your care requirements.
Some of the medical treatments and services covered by an I-SNP plan include:
- Vaccines, including flu shots and the shingles vaccine
- Prescription medications
- Ambulance services
- Mental health services
Read Also: Why Sign Up For Medicare At 65
How Much Will My Out
The costs for an I-SNP vary from plan to plan, just like they do for any Medicare Advantage plan. Some plans charge a monthly premium in addition to the Medicare Part B premium you are responsible for. Others may pay a portion of the Part B premium. Your plan may also have an annual deductible you must meet before your costs are covered. Other out-of-pocket costs may include coinsurance and copayments for medical services and treatments, medications, and durable medical equipment.
What Is A Special Needs Plan
A special needs plan is a Medicare Advantage coordinated care plan specifically designed to provide targeted care and limit enrollment to special needs individuals. A special needs individual could be any one of the following:
A SNP may be any type of MA CCP, including either a local or regional preferred provider organization plan, a health maintenance organization plan, or an HMO Point-of-Service plan. There are three different types of SNPs:
Don’t Miss: Does Medicare Come Out Of Your Paycheck
