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Chronic Conditions & Medicare: Special Needs Plan ("SNP")

When you sign up for a Medicare Advantage plan you may qualify for a Special Needs Plan or (“SNP”).  These plans provide additional benefits for those individuals who may havea. Chronic Condition. 

These SNPs are required to limit the access to this specific plans for beneficiaries who have a specific illnesses, chronic conditions, or circumstances such as being eligible for both Medicare and Medicaid. 

Special Needs Plans tailor their plan benefits, network and drug formulary to meet the specific needs of individuals who have these specific health conditions or circumstances. All Special Needs Plan have the added benefit of including Medicare Part D prescription drug coverage which often include a broader drugs formulary at a lower price.

Just like all Medicare Advantage plans, you are required to have signed up for Medicare Part A and Part B. You also must live in the plan’s service area.

Let’s review some of the types of Special Needs Plans and how they work:

Chronic Illness Special Needs Plan

Unlike a more general Medicare Advantage plan that many Medicare beneficiaries will sign up for,  Medicare Advantage Special Needs Plan (SNP) are designed for specific health conditions such as individuals who have been diagnosed with Type 2 diabetes.  Because these conditions are considered a chronic illness Medicare has created these special plans to better help these individuals.

Not all Medicare Advantage Insurance Carriers include all of the specific types of chronic conditions so it is important to reach out to one of our Agents to make sure you are signing up with the right Carrier.  

When you enroll into a SNP the Insurance Carrier will put you into a specific Network of providers that specialize in your specific condition.  These providers work together to coordinate your individual care. The Network or Insurance Carrier will often assign a care coordinator or case manager to assist you with keeping healthy, managing your health condition and following your provider’s orders. They might also help you with accessing community resources or getting the right prescriptions in a timely manner.

It is important to mention, these Doctors who specialize in your condition do not replace your primary care Doctor.  They work together with your primary care Doctor to coordinate all of your healthcare needs.

Depending on your Chronic condition that you are dealing with, you may have access to a special drug formulary which could include low to zero dollar drug cost co-pay that are dealing with your specific need.  For Instance if you suffer from Diabetes you may be able to obtain insulin at little to no cost.  In addition, you may have access to a specific facility that can help you manage your diabetes and in some cases help you no longer be a diabetic.  If you were enrolled with the same Medicare Advantage Carrier but on a non SNP those same drugs could be excluded or come at a much higher cost.

To qualify for a chronic illness SNP, you must have one or more of the following health conditions listed below:

  • Autoimmune disorders
  • Cancer
  • Cardiovascular disease, stroke, or chronic heart failure
  • Alzheimer’s or Dementia
  • Diabetes
  • ESRD requiring dialysis
  • Hematologic disorders
  • HIV or AIDS
  • Chronic lung disorders (like COPD)
  • Chronic or disabling mental illness
  • Neurologic conditions

 

After you sign up for a SNP, your Doctor will be required to complete a chronic condition verification form. It is important that you follow up with your Primary Care Doctor to ensure they complete this form in a timely manner.  If your Doctor does not complete the form within the timeframe specified by the insurance carrier you will be disenrolled from the plan. 

At the time of enrollment, your enrollment book will include the needed form that has to be completed by your Doctor.  As your Medicare Advantage Insurance Agent, will bring this form to your attention, so you can make sure your Doctor receives the needed form.  

As previously mentioned Chronic Illness SNPs program access vary by Insurance Carrier, the State and County you live in. Not all areas offer these coverage enhancements which makes having an Independent Medicare Insurance Agent all the more important.  We are able to quickly locate or determine if these plans are available to you or not.    

What a Medicare SNP Costs

You might be thinking all of these value added benefits probably will cost me a fortune.  In many of the SNP plans that we have reviewed, these plans do not end up costing more but less.

Depending on your local area we have seen, many of these plan come with zero dollar monthly premiums.  In addition copays can be set at zero or a very low co-pay amount.  Of course you have the dreaded max out-of-pocket costs but many times because many of the services have such a low or zero dollar co-pay you may not experience a major financial hardship.  Special needs plans are usually HMO style plans, so it is important that you use Doctors that are within your specific network to ensure the medical services you receive are covered by the plan. 

You should know that:

  • If you qualify for both Medicare and Medicaid, or if you have limited income, these program can help offset some or all of your cost.  
  • Your costs will vary depending on the SNP you choose, most plans do have some basic costs you will not be able to get around 

Before you join a SNP, make sure you review all of the plan details so you are fully aware of all associated cost related to the plan you are considering.

Have Questions about Medicare Special Needs Plans?

Our agency works with a number of Medicare Advantage Special Needs Plans. We could also discuss the benefits of a Medigap policy and how these would compare to a Medicare Advantage plan.  Give our team a call to see if we can help you find the right SNP for you.