Understanding the types of Medicare Advantage Plans can be tricky, especially if you’re new to the world of Medicare, how it works, and how to apply. It can be even trickier if you are an individual with a certain illness or taking care of someone with special needs to know what kind of coverage to look for. This is where the Special Needs Plans (SNPs) come in – this is a type of Medicare Advantage Plan specifically tailored to meet the needs of individuals with certain chronic illnesses, disabilities, or special healthcare needs. These plans are designed to provide targeted care and services to help manage and treat complex medical conditions and address people’s unique needs.
Who is Eligible?
There are three types of SNPs. To be eligible for one, an individual must meet the following criteria:
Chronic Condition SNP
This type of plan is designed for individuals with specific chronic conditions such as diabetes, HIV/AIDS, dementia, heart failure, chronic lung disease, autoimmune disorders, and more. To be eligible for a Chronic Condition SNP, individuals must have the designated chronic condition listed in their medical records
Dual Eligible SNP
This type of plan is for individuals who are eligible for both Medicare and Medicaid. These individuals often have low incomes and may have complex medical needs. To be eligible for a Dual Eligible SNP, individuals must be enrolled in both Medicare and Medicaid.
Institutional SNP
This type of plan is for individuals who reside in certain institutions, such as a nursing home, rehabilitation hospital, or psychiatric hospital for example. To be eligible for an Institutional SNP, individuals must live in a designated institution for 90 days straight. You may be eligible prior to receiving care if you will be receiving long-term care for 90 days or more.
What is Covered Under an SNP?
All SNPs provide drug coverage. They are also designed to coordinate and tailor their benefits to meet the needs of each individual. For individuals with chronic conditions, these benefits may include coordination of care, disease management programs, and assistance with managing medications. For those with a Dual Eligible SNP, you can be provided with an integrated approach to coordinating benefits and services to simplify the healthcare system and receive the care you need. For those with Institutional SNP, you’ll be provided with specialized care and services tailored to your unique living situation.
How & When to Join an SNP
If you have met all criteria, you can join an SNP during any of the regular Medicare Advantage enrollment periods, or, you may be eligible to join during the Special Enrollment Period (SEP).
Medicare Advantage Enrollment Period
There are a few enrollment periods each year that you’ll want to pay close attention to:
- Annual Enrollment Period: October 15 – December 7
- Medicare Advantage Open Enrollment Period: January 1 – March 31
You may also be eligible for a Special Enrollment Period (meaning any time outside of the other dates above) depending on certain life events such as losing health coverage, having a baby or being diagnosed with a severe, chronic or disabling condition.
Other Important Information Regarding SNPs
If you want to join an SNP, you’ll need to call Medicare or the plan directly as SNPs are not available everywhere, however, before enrolling, it’s best to speak to an expert first so you can make a well-informed decision. It’s also important to note that if you no longer meet the SNP’s eligibility criteria, you will be disenrolled. You’ll receive a note ten days before your coverage ends explaining that if you no longer require coverage, it will end, otherwise, you have a certain timeframe to regain eligibility. And, just remember that not every doctor, nursing home, etc. is part of the Medicare network. Before enrolling, make sure you’re checking where the providers are near you and if their locations are convenient, what costs/services will be covered, if there’s an annual limit on out-of-pocket costs, if you need a referral to see a specialist, and more.
Work With an Expert to Help You Navigate the World of Medicare
By working with an expert, such as Wise Insurance, you can rest assured knowing that you’re making the best decision for yourself or your ill family members. You can also ensure you are asking the right questions and receiving care that best suits your unique needs to improve health outcomes and quality of life. Our team will answer all of your questions in great detail and be with you every step of the way.
Emily Trevino, Senior Managing Partner at Wise Insurance, leverages her extensive background in biology and business finance to master Medicare, health insurance, and retirement planning. With over a decade in the field, Emily has co-authored “Medicare Breakdown – The Alphabet Soup of Medicare,” marking her as a pivotal figure in insurance education. Her commitment extends through active participation in the National Association of Benefits and Insurance Professionals (NABIP) and speaking at major industry events. Emily’s drive for community service and personal resilience shines through her adventurous pursuits and dedication to societal well-being. Connect with Emily on LinkedIn to explore the future of informed insurance decisions.
