Medicare Special Needs

Medicare Special Needs

A Medicare Special Needs Plan (SNP) provides benefits and services to people with specific conditions, certain health care needs, or who also have Medicaid. SNPs include care coordination services and tailor their benefits, provider choices, and list of covered drugs (formularies) to best meet the specific needs of the groups they serve. SNPs are either HMO or PPO plan types, and cover the same Medicare Part A and Part B benefits that all Medicare Advantage Plans cover. However, SNPs might also cover extra services for the special groups they serve. For example, if you have a severe condition, like cancer or congestive heart failure, and you need a hospital stay, an SNP may cover extra days in the hospital. You can only stay enrolled in an SNP if you continue to meet the special conditions of the plan.

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Medicare Special Needs Plans: Frequently Asked Questions

  • What are Medicare Special Needs Plans (SNPs)?
    Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage plan designed for people with specific health needs or conditions.
  • How do Medicare SNPs work?
    SNPs provide tailored benefits and services for individuals with specific health conditions, such as chronic illnesses, disabilities, or certain diseases. They aim to provide specialized care and support to meet the unique needs of each member.
  • Who can join a Medicare SNP?
    To join a Medicare SNP, you must meet the eligibility criteria specified by the plan. Typically, eligibility is based on factors such as having a certain chronic condition, living in a specific geographic area, or being eligible for both Medicare and Medicaid (dual eligible).
  • What do Medicare SNPs cover?
    Medicare SNPs offer all the benefits of Original Medicare (Parts A and B), and often include additional benefits tailored to the specific needs of the plan's members. These benefits may include prescription drug coverage, vision and dental care, transportation services, care coordination, and more.
  • How much do Medicare SNPs cost?
    The costs of Medicare SNPs vary depending on factors such as the plan's coverage, your location, and your eligibility for financial assistance programs. You may still need to pay your Medicare Part B premium, and some plans may have additional premiums or cost-sharing requirements.
  • Can I join a Medicare SNP if I have a pre-existing condition?
    Yes, you can join a Medicare SNP regardless of any pre-existing conditions. SNPs are specifically designed to provide targeted care and support for individuals with specific health needs or conditions.
  • When can I enroll in a Medicare SNP?
    You can enroll in a Medicare SNP during the Annual Enrollment Period from October 15 to December 7 each year, or during a Special Enrollment Period if you qualify due to certain life events, such as moving to a new area or losing other coverage.
  • How do I choose a Medicare SNP?
    When choosing a Medicare SNP, consider factors such as the plan's coverage, benefits, network of providers, and whether it meets your specific health needs.

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