Medicare Special Needs Plans

Special medical circumstances demand tailored attention, which is why Medicare Special Needs Plans (SNPs) were developed with this concept at their core.

SNPs are Medicare Advantage Plans designed to cater to individuals with specific health conditions or situations.

The network, benefits, and drug formulary of the plan are focused on the patient’s condition to offer tailored support. A number of SNP plans also appoint care coordinators to aid patients in handling their condition, adhering to medical instructions, utilizing community services, and acquiring prescriptions promptly.

To be eligible for a Special Needs Plan due to chronic illness, the Medicare recipient must have a diagnosis of one or more of the following conditions:

Chronic illness SNPs differ across regions, as insurance companies determine the availability of specific plan designs. Consequently, not all patients with chronic conditions may find a suitable plan tailored to their needs in their vicinity. Moreover, relocating to a new residence in a different coverage area can affect eligibility. Seek guidance from a licensed insurance professional for further assistance in finding these plans.

Other categories of Special Needs Plans consist of Institutional SNPs and Dual-Eligible SNPs. Patients projected to be institutionalized for 90 days or more may qualify for an Institutional SNP, which aims to manage the care of individuals no longer residing independently.

Dual-Eligible Special Needs Plans

Dual-Eligible Special Needs Plans, known as DSNPs, are accessible to individuals who are enrolled in both Medicare and Medicaid. Medicaid often covers the premiums as well as a substantial portion of co-pays and deductibles.

The benefits of many Medicare Advantage DSNP’s include the following:

Enrollment in any Special Needs Plan (SNP) is determined by location, and the individual must stay enrolled in Original Medicare. Part B premiums will continue to be paid to Social Security, unless Medicaid eligibility covers them. The SNP will require a separate premium, and the individual is accountable for co-pays and deductibles set by the plan.

Individuals who qualify for a SNP at any time during the year are entitled to a Special Enrollment Period, allowing them to choose a SNP during this timeframe.

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