If you’re a Medicare beneficiary with one of the above circumstances, you may not realize that there are Medicare plans available that are specifically designed to help you manage the complex health challenges that may come with your situation.
Special Needs Plans tailor their benefits and services for Medicare beneficiaries with unique health or situational challenges. Here’s an overview of how they work, including what they cover, eligibility, and how to enroll.contact medicare insurance brokers Arizona
There are three different types of SNPs:
A special needs plan (SNP) is a Medicare Advantage (MA) coordinated care plan (CCP) specifically designed to provide targeted care and limit enrollment to special needs individuals. A special needs individual could be any one of the following:
1. An institutionalized individual,( Institutional SNP) (I-SNP).
2. A dual eligible, SNP (D-SNP).
3. An individual with a severe or disabling chronic condition, SNP (C-SNP) as specified by CMS.
A SNP may be any type of MA CCP, including either a local or regional preferred provider organization (i.e., LPPO or RPPO) plan, a health maintenance organization (HMO) plan, or an HMO Point-of-Service (HMO-POS) plan.
Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.
Like all Medicare Advantage plans, these plans must cover the same benefits as Original Medicare, Part A, and Part B, with the exception of the hospice benefit (which is still covered under Original Medicare). Medicare Advantage Special Needs Plans may also include coverage beyond Part A and Part B, such as routine vision and dental, hearing services, or wellness programs. Unlike other types of Medicare Advantage plans that may or may not cover prescription drugs, these plans always include prescription drug coverage.
Generally, you must get your care and services from doctors or hospitals in the Medicare SNP network, except:
– Emergency or urgent care, like the care you get for a sudden illness or injury that needs medical care right away.
– If you have End-Stage Renal Disease (ESRD) and need out-of-area dialysis.
Medicare SNPs typically have specialists in the diseases or conditions that affect their members.