Medicare Special Needs Plans... Explained.

Medicare Special Needs Plans are a type of Medicare Advantage Plan for individuals with specific circumstances. Special Needs Plans include Chronic Special Needs Plans C-SNP for individuals living with chronic illnesses, Institutional Special Needs Plans I-SNP for individuals who live in an institution such as a nursing home and Dual Special Needs Plans D-SNP for individuals who are dual-eligible meaning they have both Medicare and Medicaid.

Medicare Special needs Plans cover the similar services to other Medicare Advantage plans but may also offer extra services tailored to the eligible group’s specific circumstances. Individuals who qualify for a Medicare Special Needs plan may also be eligible for a Special Enrollment Period, meaning they could make changes to their plan outside of the Annual Enrollment Period.

Let’s go over the types of Medicare Special Needs Plans:
Chronic Special Needs Plans
Chronic Special Needs Plans are a type of Medicare Advantage Plan for individuals with chronic conditions. Some examples of chronic conditions that qualify an individual for a Chronic Special Needs Plan include but are not limited to:
Autoimmune disorders
Cancer
Chronic heart failure
Diabetes
End stage renal disease
HIV/AIDS
Chronic lung disorders
And Neurologic disorders

C-SNPs generally include extra benefits, provider networks, and cost-sharing structures specific to the plan’s designated chronic condition.

Institutional Special Needs Plans
Institutional Special Needs Plans are designed for individuals who need institutional care. To qualify for an I-SNP, - for 90 days or longer, you must have needed or are expected to need long-term care services, skilled nursing facility care, care in a facility for individuals with intellectual disabilities, or an inpatient psychiatric facility.

Dual-Special Needs Plans
If you qualify for both Medicare AND Medicaid, you may be eligible to enroll in a Dual Special Needs Plan which can help cover some services that Original Medicare doesn’t cover like dental, vision, hearing, over-the-counter benefits and more. Often Dual Eligible Special Needs Plans offer lower cost-sharing structures than regular Medicare Advantage plans.

To be eligible for a D-SNP, you must be eligible for Medicare and meet one of the following Medicaid categories:
Qualified Medicare Beneficiary without other Medicaid (QMB Only)
QMB Plus
Specified Low-Income Medicare Beneficiary without other Medicaid (SLMB Only)
SLMB Plus
Qualifying Individual (QI)
Qualified Disabled and Working Individual (QDWI)

If you want to learn more about the Medicaid categories of eligibility, see our Understanding Medicare and Medicaid video.

Need help determining if you qualify for a Special Needs Plan? If you would like assistance in navigating your Medicare options, please reach out to us and we’d be happy to help. Give us a call or visit us online today at 1-833-438-3676.

свернуть