Could a Medicare Special Needs Plan Be Right for You?

A Special Needs Plan (SNP) customizes medical benefits for individuals who have chronic illnesses, are on Medicaid, or live in specific institutions. SNPs are offered under Medicare Advantage, with figures showing that enrollees under this plan may hit 28% by next year.

What should you know about SNPs?

They cover hospital care (Part A), physician visits and some other charges (Part B) and prescription drugs (Part D).

There are three kinds of SNPs;

1. Chronic condition SNPs

These plans cover patients with disabling or severe chronic diseases like diabetes, stroke, chronic heart failure, and cancer.

1. Dual-eligible SNPs

This covers individuals eligible for both Medicaid and Medicare. Individuals who wish to enroll to this particular SNP need to meet their state’s requirements for asset limits and income.

• Institutional SNPs

This covers individuals who live in a medical institution for at least ninety days. These include nursing homes, inpatient psychiatric facilities, and long-term care facilities.

How do you know if you qualify for an SNP?

Individuals who’d like to enroll to a SNP must meet the aforementioned health requirements or income requirements. This is in addition to qualifying for a Medicare Advantage (MA) plan, which involves enrolling in Original Medicare Parts A and B and living in a service area under the Medicare Advantage plan.

What else should you know?

Once you’ve determined you’re eligible, you can choose a plan. The best time to do this is during Medicare open enrolment, which is open till December 7^th. If you’re currently under an MA plan, you can switch your plan during the open enrolment period, which will run from January 1^st to March 31^st next year.

Individuals who develop qualifying chronic conditions are also eligible to enroll in a chronic condition SNP even when the enrolment period has lapsed. In addition to checking out SNPs available in your area on the Medicare.gov search page, individuals can also:

• Ensure their medications are covered under the plan they want to enroll in
• Compare how and if the plan covers your current specialists and physicians
• Look up how SNP offers special services
• Review customer feedback and other ratings, with higher star ratings indicating better quality of care and customer service from healthcare providers
• Research other special benefits that SNPs offer, including home health coverage and dentures
• Compare how much you’ll pay for prescriptions, doctor’s visits and premiums

Individuals may benefit from using healthcare agents and brokers to compare options and determine which plans they may qualify for. It is also helpful to reach out to MA plan providers like Astiva Health or any other within your area so that you get accurate information about the policy options available to you.

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