Understanding Medicare Special Needs Plans

By: Christian Worstell

If you are diagnosed with a chronic illness, need long-term care or are dual-eligible for Medicare and Medicaid, then you may be eligible for a Medicare Special Needs Plan (SNP).

Medicare Special Needs plans are a type of Medicare Advantage plan, and an SNP – if one is available where you live – may offer some benefits that are helpful for your situation.

What is a Medicare Advantage Plan?

If you are covered by Original Medicare (Part A and Part B), the federal government provides your Medicare benefits when you receive covered services.

 If you choose to join a Medicare Advantage plan (Medicare Part C), the federal government pays approved private companies to cover your Medicare benefits.

A Medicare Advantage plan will provide coverage for your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), but these benefits will be provided by the private insurance company that provides your plan.

A Medicare Advantage plan is different from a Medicare Supplement Insurance policy, and you cannot have Medicare Supplement Insurance and Medicare Advantage at the same time.

Different Types of Medicare Advantage Plans 

There are five different types of Medicare Advantage plans to choose from. The choices can include: Health Maintenance Organization plans, Preferred Provider Organization plans, Private Fee-for-Service plans, Special Needs Plans, and HMO Point-of-Service plans.

Each plan offers a different range of services depending on the needs of the client. If you have both Medicare and Medicaid, are living in a nursing home, or have a chronic medical condition, you may be able to apply for a Special Needs Plan.

Special Needs Plans

Medicare SNPs offer the same coverage as Medicare Part A and Part B combined into one plan. Medicare SNPs also include drug coverage.

SNPs are limited access; only people who have specific diseases or characteristics are accepted.

You may be eligible for a Special Needs Plan if you have a chronic health condition like cancer, an autoimmune disease, cardiovascular disorders, dementia, liver disease, HIV/AIDS, and more.  

You might also be eligible if you already have Medicare and Medicaid. Each SNP is tailored to fit the needs of the individual.

If you are unsure whether or not you may be able to enroll in an SNP, you can consult your doctor during your annual wellness visit or call 1-800-MEDICARE (1-800-633-4227).

Enrollment in a Special Needs Plan

If you are enrolling in Medicare for the first time, you can sign up during your Initial Enrollment Period. This period starts the three months before your 65th birthday, includes your birth month, and continues for three more months after that.

You may be able to enroll in a Medicare SNP during the annual Medicare Open Enrollment Period from October 15th to December 7th.  

You may also be able to enroll in a Medicare SNP if you are granted a Special Election Period.  

To be granted a Special Election Period, you must already have Medicare and then develop a chronic health condition, be moved into a nursing home or other care facility, be moved out of your current SNP coverage area, become eligible for Medicaid, or have your SNP leave the Medicare program.

Purchase a Special Needs Plan

To purchase a Medicare SNP, you first need to find an SNP in your area. To do that you can:

●      Call Medicare at 1-800-MEDICARE (1-800-633-4227)

●      Enroll online using the Medicare Plan Finder: www.medicare.gov/find-a-plan

●      Contact your local State Health Insurance Assistance Program (SHIP)

Afterward finding a Medicare SNP in your area, you will need to complete an application. These can be done online or mailed with a form, depending on the SNP.

It is important to note that you will have to choose a primary doctor within your SNP network. You will also have to use doctors, hospitals, and other providers in your network, with the exception of emergency medical care.

Medicare SNP costs depend on the type of plan tailored to you, so it is important to ask what you will be expected to pay.

If it turns out that your SNP is not meeting your needs, you can return to Original Medicare. Makes sure to consult with your doctors, providers, and family members when making any major medical decision regarding your coverage.

Author Bio: Christian Worstell is a health writer living in Raleigh, NC.