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Special Needs Plans (SNPs)

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A Special Needs Plan is a specific type of coordinated care plan. These are a special type of Medicare Advantage plan that private insurance providers provide to qualified consumers.

What is a Special Needs Plan?

Special Needs Plans are unique varieties of Medicare Advantage plans with benefits that address particular medical or financial requirements. Prescription drug coverage is included in all SNPs, but the plans’ accessibility will vary depending on where you live. Special Needs Plans come in four different variations.

  • Dual Special Needs Plans (D-SNPs) for those who are “dual eligible”, they have both Medicare and Medicaid
  • Chronic Special Needs Plans (C-SNPs) for those suffering from severe or incapacitating chronic diseases
  • Institutional Special Needs Plans (I-SNPs) for residents of skilled care facilities
  • Institutional-Equivalent Special Needs Plans (IE-SNPs) for individuals who reside in an assisted living facility under contract and require the same level of care as those who do so.

 

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What do Special Needs Plans Cover?

The same medical treatments that all Medicare Advantage plans, including Medicare Part A and Part B, must provide are also covered under Special Needs Plans. However, all Special Needs Plans are mandated to offer prescription drug coverage. Some SNPs may also include additional services targeted to the particular demographic they are intended to benefit from. To find out precisely which benefits and services will be covered, you should carefully study each plan for which you could be eligible.

What is a Dual Special Needs Plan (D-SNP)?

Plans for dual special needs are available to those with both Medicare and Medicaid (called “dual eligible”). A special type of Medicare Advantage plan known as a Dual Special Needs Plan (D-SNP) combines your Part A, Part B, and Part D prescription drug benefits. To help coordinate the plan with your Medicaid plan, you’ll receive additional assistance. A dual health plan also offers extra advantages that neither Medicare nor Medicaid does.

Who qualifies for a Dual Special Needs Plan?

You must have Original Medicare (Parts A and B) and complete Medicaid benefits in order to be eligible for a D-SNP. You might be referred to as a “full dual-eligible” or a “partial dual-eligible” depending on how much Medicaid benefits you receive. You will be fully dual-eligible if you obtain all Medicaid benefits. People who are eligible typically receive a letter from the Medicaid office of their state. To find out your situation, you can also call.

What extra benefits may be included with a Dual Special Needs Plan?

Coverage for your teeth, eyes, and ears, care coordination through a personal care coordinator, a personal emergency response system (PERS), telehealth alternatives including virtual doctor visits, credits to use toward the purchase of health products, transportation assistance, and more are all available. These are only a few illustrations of the additional advantages that Dual Special Needs Plans often provide. Every plan is unique, so make sure to check what is offered where you reside.

What happens to my Medicaid benefits?

Neither your Medicaid eligibility nor your Medicaid plan is affected by a dual special needs plan. You’ll keep your current Medicaid plan and continue to receive all of your current Medicaid benefits.

 

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What is a Chronic Special Needs Plan (C-SNP)?

People with severe or incapacitating long-term health issues are eligible for chronic special needs plans (C-SNPs). Some plans, such as those for those with diabetes or chronic heart failure, are solely intended for those who have a particular ailment.

The Centers for Medicare & Medicaid Services (CMS) has authorized the following 15 chronic diseases specific to SNPs:

  • chronic reliance on alcohol and other drugs
  • The following autoimmune diseases are excluded: Systemic lupus erythematosus, Polyarteritis nodosa, Polymyalgia rheumatica, Polymyositis, and rheumatoid arthritis.
  • Cancer (excluding pre-cancer conditions or in-situ status) (excluding pre-cancer conditions or in-situ status)
  • Cardiac arrhythmias, coronary artery disease, peripheral vascular disease, and chronic venous thromboembolic disorder are the only cardiovascular conditions included.
  • persistent heart failure
  • Dementia
  • Diabetes mellitus
  • chronic liver disease
  • the need for dialysis due to end-stage renal disease
  • Aplastic anemia, hemophilia, immune thrombocytopenic purpura, myelodysplastic syndrome, and sickle-cell disease are among the most severe hematologic illnesses (excluding sickle-cell trait)
  • HIV/AIDs
  • Asthma, chronic bronchitis, emphysema, pulmonary fibrosis, and pulmonary hypertension are the only chronic lung diseases.
  • illnesses of the mind that are persistent and incapacitating, such as schizophrenia, bipolar disorder, major depressive disorder, paranoid disorder, and schizophrenia
  • Amyotrophic lateral sclerosis (ALS), epilepsy, extensive paralysis (hemiplegia, quadriplegia, paraplegia, and monoplegia), Parkinson’s disease, Huntington’s disease, multiple sclerosis, polyneuropathy, spinal stenosis, and stroke-related neurologic deficiency are among the neurological conditions.
  • Stroke

Various C-SNPs are offered depending on the firm. To find out if a plan provider offers one that satisfies your medical needs, you must inquire directly with them.

What is an Institutional Special Needs Plan (I-SNP)?

Institutional Special Needs Plans (ISNPs) are for people who receive nursing care at home or at a care facility like a nursing home. These plans are intended for those who have required—or are anticipated to require—the level of services offered in one of the following for 90 days or more:

  • a center for long-term care and skilled nursing
  • a center for long-term nursing care.
  • a nursing home or skilled care institution
  • a center of intermediate care for people with intellectual disabilities
  • a mental health center with inpatients

 

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What is an Institutional-Equivalent Special Needs Plan (IE-SNP)?

Individuals who reside in an assisted living facility and receive care equivalent to that provided in a skilled nursing facility are eligible for Institutional-Equivalent Special Needs Plans (IE-SNPs).

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