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Special Needs Plans

5 Things You Should Know About Medicare Special Needs Plans

Posted on September 9, 2022 by Austin Lang

Medicare Isn’t One Size Fits All

One of the most important things to consider when choosing a healthcare plan, Medicare or otherwise, is whether it meets your needs. For most people, regular health checkups and hospital coverage is sufficient, but what if you have a chronic condition? 

Finding out a crucial service or medication isn’t covered by your insurance is terrible, especially after you’re already locked in for the year. Medicare Advantage plans offer additional coverage, but sometimes this coverage just isn’t what you need. You need a bespoke plan. One that covers people in your situation. 

If you have a chronic condition, or meet other qualifying circumstances, you may be eligible for one of the many Medicare Special Needs Plans (SNPs) on the market. These Medicare Advantage plans are tailor-made for people in particular medical, financial, and living situations

What are the benefits of a Medicare special needs plan? How do you know if you qualify? Here are five things you should know.

5. More People Qualify for SNPs Than You Might Think

Woman in wheelchair with caregiver

There are three types of Special Need Plans available on the market.

  • Institutional SNPs (I-SNPs) are designed for people living in institutional settings, like nursing homes, rehabilitation facilities, and long-term care facilities. They’re usually offered through the institution and cover services that the institution provides. 
  • Dual Eligible SNPs (D-SNPs) are designed for people who are eligible for both Medicare and Medicaid. These plans are designed to help coordinate your Medicare and Medicaid benefits, allowing you to make the most of both services.
  • Chronic Condition SNPs (C-SNPs) are designed for people with a chronic health condition. They provide services to treat that condition, such as appointments with specialists or specific equipment.

Of the three, C-SNPs are probably the most common, and the one you’re most likely to be eligible for without realizing it. C-SNPs cover a variety of common conditions, including:

  • Addiction
  • Anxiety
  • Cancer
  • COPD
  • Depression
  • Dementia
  • Diabetes
  • Heart Disease
  • HIV/AIDS
  • Stroke

Your doctor may be able to help you if you’re looking for a specific SNP. You’ll also need a doctor’s note to enroll, so getting in contact with your primary care physician is a good idea.

4. SNPs Cover Everything Original Medicare Does and More

Diabetic supplies, including insulin pen and glucose tester

SNPs are a type of Medicare Advantage plan, which means they are required by law to provide all the coverage Original Medicare provides. This means you don’t need to worry about missing doctors visits, or not being able to pay for hospital stays. Even if you choose an I-SNP, you’re still eligible for care your institution does not provide, like specialist treatments and hospital stays.

However, these plans also provide benefits tailored to your specific circumstances. For instance, a C-SNP for diabetes will cover insulin, glucose monitoring equipment, and treatment for conditions like neuropathy. It might also cover things like meal delivery, healthy snacks, and nutritional counseling. On the other hand, an I-SNP will cover all the services you’re likely to use at the institution and may include additional provisions for comfort or special accommodations.

3. All Medicare Advantage Special Needs Plans Include Prescription Drug Coverage

Prescription Drugs

SNPs are required by law to cover prescription medication, giving them a noticeable edge over typical Medicare Advantage plans. These plans also have tailored formularies that are specifically designed to make medicines you’re likely to need more affordable. 

Ordinary Medicare Advantage and Medicare Part D plans have broad formularies based on how frequently drugs are prescribed. This makes common drugs relatively cheap, but can leave you paying out of pocket for rarer medications. 

A C-SNP, however, targets those condition-specific drugs first. A SNP dedicated to treating cancer is likely to have more cancer-related drugs on their formulary than a Medicare Part D plan, and those drugs are likely to be less expensive overall. 

2. Medicare SNPs Coordinate Your Care

A team of doctors

Traditionally, healthcare is managed by the patient, who is responsible for making appointments, relaying information between doctors, and keeping track of details. For someone with a chronic condition, this is exhausting. That’s why SNPs include the service of care coordinators: medical professionals responsible for coordinating your treatment across health care providers. 

They’ll make sure you’re receiving the services you need, serve as a go-between for doctors, and can help you find in-network providers for critical services.

1. SNPs Have the Financial Advantages of Medicare Part C

Piggy Bank

Because SNPs are private insurance plans, they don’t have the same financial burden that Original Medicare might have. 

 

Private plans have out-of-pocket maximums, putting a cap on the amount of money you’ll need to pay toward cost sharing and deductibles. Hit the maximum, and your insurer will cover the rest for the remainder of the year. Some plans may waive cost-sharing and deductibles entirely, leaving you only with your monthly premium. 

Others might cover the monthly premium for Medicare Part B, saving you even more money. Many Medicare Advantage plans have no premiums at all. Coverage and benefits vary, and you’ll be accepting a smaller network in exchange for these financial perks, but you can save a noticeable amount of money by choosing an SNP.

SNPs, like any other Medicare Advantage plan, aren’t for everyone. Plans for your condition or circumstances may not be available in your area, and the available plans may not have your specific providers in-network.

If you’re considering enrolling in an SNP, contact one of our licensed insurance agents at (800) 950-0608. They can help you compare your options and find a plan that fits your unique circumstances. You can also enter your zip code into our free comparison tool below to start comparing plans today.

About the Author

Austin Lang

Austin is dedicated to breaking down complex topics, like Medicare, in a way that's easy to understand. He graduated with an M.A. from Florida Atlantic University in 2018.

Comments (1)

JudyMcl

Good Job Austin ! I hope you will continue to write clearer explanations
Some times these statements are hard to understand & it is difficult to find someone on the phone to help .

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