What Are Medicare Special Needs Plans?

A Medicare Special Needs Plan (SNP) is a Medicare Advantage Plan that provides organized care for people with special needs. 

Health Plans of NC, Kelly Quinn
Two older patients with a doctor seated in a hallway

How do Medicare Advantage Special Needs Plans work?

Like other Medicare Advantage plans, SNPs have an established network of providers, typically either an HMO or a PPO. An SNP is required to feature the same services as Original Medicare. 

Some SNPs offer restricted membership. For example, they may only be available to beneficiaries with specific circumstances, illnesses, or chronic conditions. SNPs also adjust their plan benefits, network, and drug formulary for an individual’s needs. All SNPs include Part D drug coverage. 

Types of Special Needs Plans

There are various types of SNPs that all work in unique ways. 

Chronic Illness SNP

This plan offers support for anyone suffering from a chronic illness. For example, the plan may provide access to a network of providers who provide expert care for specific illnesses. 

Providers who offer these plans typically work with you to organize and support your care needs. For example, your plan usually gives you a care coordinator who helps you access necessary resources, helps you follow your provider’s orders, and manages your health condition. Your plan’s built-in drug formulary also typically includes coverage for drugs that treat your specific health condition.  

To qualify for this type of plan, you need to have one or more health conditions, including: 

  • Cancer

  • HIV or AIDS

  • Diabetes

  • Neurologic conditions

  • Chronic lung disorders

  • Autoimmune disorders

  • Chronic mental illness

  • Hematologic disorders

  • Alzheimer’s or Dementia

  • ESRD requiring dialysis

  • Cardiovascular disease, chronic heart failure or have suffered from a stroke

Chronic Illness SNPs aren’t available in every county, so it’s an excellent idea to contact one of our specialist North Carolina Medicare agents. We can help you find whether an SNP is available to you in North Carolina that specializes in treating your specific condition. 

Institutional SNP

If you’re a Medicare beneficiary who lives in an institution such as an assisted living center or a nursing home, you may be eligible to enroll in an Institutional SNP. These plans are similar to Chronic Illness SNPs. However, they focus on providing organized care to anyone no longer living alone. In addition, they expect you to live within the institution for at least 90 days to be eligible.

Dual Eligible SNP

As a beneficiary, you may also qualify for Medicaid, which is designed for people with low incomes. When you’re eligible for both Medicare and Medicaid, you can keep your Original Medicare and Medicaid operating as your secondary coverage. Alternatively, you can sign up for a Dual Eligible SNP.

With a Dual Eligible SNP, you can expect to pay very little (or sometimes nothing) on deductibles, copays, and coinsurance for Part A and Part B services. In addition, because Medicaid covers the cost of premiums for you, most Dual Eligible SNPs have a $0 premium. 

In addition to these benefits, many plans also feature gym memberships, quarterly benefits for over-the-counter drugs, and routine vision, dental and hearing benefits. Some plans also provide transport to and from doctor’s appointments and even trips to the pharmacy.

Working with a local Medicare agent in North Carolina means we can check your eligibility for Medicaid before you enroll in a Dual Eligible SNP. Get in touch with us to find out more

How to Enroll In A Medicare Special Needs Plan

To be eligible to enroll, you need to be already enrolled in both Medicare Part A and Medicare Part B. You also need to check the plan’s service area and ensure you live in the area. Unless Medicaid provides coverage for your Part B premium, you’ll need to keep paying this premium. You’ll also have to pay the monthly premium for the SNP along with any coinsurance, copays, or deductibles. Some plans are available without a monthly premium, and working with a Medicare agent NC means we can help you determine the best plan for your health and budget. 

It’s possible to enroll in an SNP during your Initial Enrollment Period or during the Annual Election Period. You may also be eligible to enroll during a Special Enrollment Period throughout the year if you’ve been affected by a life event. Typical events may include:

  • You qualify for Medicaid 

  • You move to a different state that’s outside your current plan’s service area

  • You move in or out of an institution

  • You’re diagnosed with a chronic or severe condition, making you eligible for a Chronic Condition SNP

You can also lose eligibility for a Special Needs Plan if your circumstances change. If this happens, there will be a period where you can leave the plan to join another plan or return to Original Medicare. Again, seeking professional guidance can help to ensure you get the right plan for you. 

Questions about Medicare Special Needs Plans

If you’ve got any questions about Medicare Advantage Special Needs plans, for example, how a Medicare Advantage Dual Eligible Special Needs Plan works or whether you’re eligible, get in touch with one of our specialized agents. Our local team is based in North Carolina and understands the SNP plans available for different health needs. We can work with you to establish the right level of coverage and assist with enrolling. Contact us today to find out more or compare plans online. 

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