Those with chronic or disabling conditions need specialized care for their individual needs. And if you’re a Medicare and Medicaid member living in a long-term care institution, you might be eligible for Medicare Special Needs Plans. Here’s what you need to know.
What are Medicare Special Needs Plans?
Special Needs Plans (SNPs) are a special type of Medicare Advantage plan designed to cater to the specific needs of those with chronic or disabling conditions. They provide tailored benefits to suit the individual’s unique needs, including specialized healthcare services and drug prescriptions. Many SNPs offer a care coordinator who helps members navigate the system and develop a personalized care plan.
Special Needs Plans are offered by private insurance companies, and availability may vary depending on location and the specific type of SNP you’re looking for.
Types of SNPs
There are three main types of Special Needs Plans that you can enroll in:
- Chronic Condition SNPs (C-SNPs): These are for individuals with specific severe or disabling chronic conditions, like diabetes, heart failure, dementia, HIV/AIDS, and others as defined by the CMS.
- Dual Eligible SNPs (D-SNPs): For individuals who are eligible for both Medicare and Medicaid, otherwise known as “dual eligibles.”
- Institutional SNPs (I-SNPs): For individuals who live in an institution, like a nursing home or nursing care at home.
Each type of Special Needs Plan is designed to tailor benefits and provider networks to the specific conditions of the individual.
Eligibility requirements for Medicare Special Needs Plans
To enroll in an SNP, individuals must meet three eligibility requirements:
- Have both Medicare Part A and Part B
- Live in the plan’s service area
- Meet the specific eligibility criteria for that type of SNP, like having a chronic condition for a C-SNP, for example.
Before signing up for a Special Needs Plan, it’s important to check which SNPs are available in your area and ensure you meet the plan’s eligibility requirements. Individuals can also contact SHIP or DWSS to verify eligibility for programs.
Find a Medicare solution that works for your needs
It’s not always easy to navigate the Medicare system to find coverage that suits your needs. If you believe that you or someone you know may qualify for a Special Needs Plan, or are simply looking for the best healthcare insurance options, contact us at Health Benefits Associates.
Our trained staff can walk you through the options and help you choose a Medicare plan that works best for your needs. Schedule an appointment with an HBA agent today by calling 775-828-1216. We’d love to help you out!
