How to Qualify for the Medicare Special Needs Plan

Medicare Special Needs Plan

The Medicare special Needs Plan falls under the category of Medicare Advantage plans that allow eligible beneficiaries to receive benefits that cater to their unique needs. The Special Needs Plan (SNP) currently enrolls more than 2.3 million beneficiaries across the 600 Special Needs Plans available nationwide.

Studies have also indicated that nearly 90% of Special Needs Plan beneficiaries are often those eligible for the Dual Special Needs Plan (D-SNP), and are often those that are chronically ill and come from low-income brackets.

Studies have also indicated that the Medicare Advantage Chronic Special Needs Plan (C-SNP) has helped boost primary care and reduced hospital trips, especially for diabetic patients. SNPs provide beneficiaries with the same benefits as the Original Medicare, albeit with varying costs and eligibility criteria.

Let’s take a look at some of the SNPs that are available.

Chronic-Condition Special Needs Plans (C-SNP)

The C-SNP is made available for people that suffer from severe/disabling chronic conditions like cancer, HIV/AIDS and chronic failure of health.

Institutional Special Needs Plans (I-SNP)

I-SNP provides coverage for those who are living in a nursing home or require nursing care at home.

Dual-Eligible Special Needs Plans (D-SNP)

Dual eligible candidates are those who have both, Medicare as well as Medicaid.

What’s The Eligibility Criteria for SNPs?

The eligibility criterion to enroll in an SNP is as follows:

  • Active enrollment in Medicare Part A and Part B plans
  • Prospective beneficiaries must reside in the service area that provides SNPs
  • Must have either Medicare or Medicaid (or both)
  • Must have chronic conditions that the SNP provides coverage for

What Benefits Does The SNP Provide?

Benefits Does The SNP Provide

The Medicare advantage SNPs provide coverage extended by Medicare Part A, Part B and Part D, all through one plan. Medicare Special Needs Plans are available through Medicare-approved private insurance companies.

The benefit of enrolling in an SNP is that it also extends coverage for care-coordinated services to help beneficiaries understand their condition better. They may also link beneficiaries to getting the help they need with special dietary plans and helpful lifestyle activities that can improve their health.

Moreover, the C-SNP may also help beneficiaries link with networks of doctors, physicians and hospitals that provide specialized care for their specific conditions. For the D-SNP beneficiaries, added benefits may include making available certain social services to aid the beneficiary to coordinate with the Medicare and Medicaid programs.

How Much Does It Cost?

Depending on the SNP you require, your Plan will typically include the following costs:

  • Premium for Medicare Part B
  • Monthly premium for the SNP you need
  • Extra monthly premiums for prescription drug coverage/ additional benefits, if your SNP requires it
  • Copayments, coinsurance and/or deductibles

For D-SNP beneficiaries, the SNP costs don’t supersede the payments you would typically make for the Original Medicare plans and Medicaid.

If you are looking to enroll in a Special Needs Plan and require help with it, get in touch with Seniors for Medicare. As a team of licensed medical insurers and senior Medicare advisors in New Jersey and New York, we aim to make your Medicare journey easy and hassle-free!

Call us at 800-276-1753 to learn more.

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