Medicare Advantage SNPs

Medicare Advantage plans cover the same medical expenses as Original Medicare. There are various types of Part C plans, such as SNPs, MSAs, PFFS, PPOs, and HMOs. SNPs stand for Special Needs Plans. Special Needs Plans are tailored to suit people with chronic health conditions who need extra healthcare services. To get this type of coverage, you must be enrolled in Original Medicare. 

Medicare Advantage Special Needs Plans include Part A and Part B coverage, and also include coverage for prescription drugs. Medicare Advantage SNPs also offer extra services that aren’t covered under Original Medicare, such as dental, vision and hearing coverage. 

There are three types of SNPs: Chronic Condition Special Needs Plans, Institutional Special Needs Plans, and Dual Eligible Special Needs Plans.

Types of Special Needs Plans

Chronic Condition Special Needs Plans:

  • C-SNPs were created for Part C enrollees with severe or chronic health conditions. This plan provides the complex care these individuals need. People with certain conditions such as cancer, chronic heart failure, type 2 diabetes, HIV, and stroke are eligible for this plan. C-SNPs also cover individuals who have conditions that fall under several groups such as cardiovascular disease, lung disease, mental health disorders, and neurologic disorders.

Institutional Special Needs Plans:

  • People who need to stay in an institution for up to 90 days or more may benefit from Institutional Special Needs Plans. I-SNPs cover skilled nursing facilities, long-term care facilities, and immediate care for people with intellectual disabilities or psychiatric needs.

Dual Eligible Special Needs Plans:

  • D-SNPs may be the most complex of the three Special Needs Plans as they offer coverage to Medicare enrollees who are also eligible for Medicaid. It is suitable for people with extra healthcare needs but cannot afford the healthcare costs due to income or other issues.

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Eligibility and Enrollment

To qualify for a Part C Special Needs Plan, you must be enrolled in Original Medicare. Also, you must qualify for either of the three types of Special Needs Plans to enroll, must reside in the plan’s service area, and must keep paying your Part B premiums. 

To qualify for a D-SNP, you must be eligible for Medicare and Medicaid. To enroll in a C-SNP, you must provide a note from a physician stating the diagnosis which qualifies you to enroll. You can then start your enrollment process on phone or in person. For I-SNPs, you must stay in a facility for at least 90 days or meet the requirements for high-level care. 

To enroll in a Special Needs Plan, there are usually special enrollment periods that are offered to people who need high-level care. Apart from a special enrollment period, you can enroll during the Medicare Advantage Open Enrollment period, which begins on January 1 and ends March 31 of each year.

For more information about Medicare Advantage plans, reach out to us today.