Special Needs Plans (SNPs)
Medicare beneficiaries that have a chronic condition may be able to get a Special Needs Plan (SNP). This is a type of Medicare Advantage (MA) plan that is only available to Medicare beneficiaries with certain conditions or diseases. The plan provides coverage for office visits, hospital stays, and all other Medicare-approved services.
The major difference between Special Needs Plans and other Medicare Advantage options is that this plan provides additional services based on your individual healthcare needs, which include special social services, care management, or extra days in the hospital.
Read on to learn more about Medicare SNPs.
Types of Special Needs Plans
Special Needs Plans are broken down into three groups based on specific health needs. The three types of Special Needs Plans include:
Chronic-Condition Special Needs Plans (C-SNPs): This type of SNP plan is aimed at Medicare beneficiaries who have disabling or severe chronic conditions. Most Medicare beneficiaries meet these criteria by having one or more of the 15 conditions that are approved by CMS. These conditions include:
- autoimmune disorders
- cardiovascular disease
- cancer
- chronic alcohol or other substance dependence
- chronic heart failure
- chronic and disabling mental health conditions
- chronic lung disorders
- diabetes
- dementia
- HIV and AIDS
- end-stage renal disease
- end-stage liver disease
- neurologic disorders
- stroke
- severe hematologic disorders
Institutional Special Needs Plans (SNPs): I-SNPs are designed for Medicare beneficiaries who live in an institution or require home nursing care for 90 days or more. This includes nursing homes or assisted living, resident psychiatric centers, long-term care skilled nursing facilities, or intermediate care for beneficiaries with developmental disabilities.
Dual Eligible SNPs (D-SNPs): The D-SNPs provide additional coverage to those eligible for both Medicare and Medicaid. These plans tend to cover the utmost healthcare needs.
Eligibility and Enrollment Period for Special Needs Plans
To be eligible for an SNP, you must have already enrolled in Original Medicare and must qualify for I-SNP, D-SNP, or C-SNP. Also, Special Needs Plans are not the same and are not provided in every state.
If you are newly eligible for Medicare, you can sign up for an SNP during the initial enrollment period. Those that have already signed up for Original Medicare can sign up for SNP during the next open enrollment period. However, if you have a certain condition or disease and are admitted to a nursing home, you can sign up for a Special Needs Plan at any time.
What a Special Needs Plan Costs
Your out-of-pocket costs will be determined by how frequently you require care and the type of healthcare you need. Using a doctor or hospital within or out of your SNP’s network will also determine the cost, as all SNPs require you to receive care within their network of providers in order to receive coverage. However, if you qualify for both Medicare and Medicaid, you will be able to get the care you need without spending much money.
Also, your cost will vary depending on the type of SNP you opt for.
Before signing up for a Special Needs Plan, you may want to contact a professional Medicare expert to help you understand what you will be expected to pay and how you will be covered. For more information about Special Needs Plans (SNPs), contact Simple Retirement Benefits today.
