Types of Medicare Advantage Special Needs Plans
Dual Special Needs Plans | Chronic Special Needs Plans | Institutional Special Needs Plans
Medicare Advantage Special Needs Plans (SNP) are a special category of plans geared towards helping people who may need extra assistance due to low income, chronic health conditions or for those who may be institutionalized.
These plans always include Part D prescription drug coverage and tailor their benefits and drug formulary to meet the specific needs of those who qualify.
Dual Special Needs Plans (D-SNP)
Medicare Advantage Dual Special Needs plans are HMO or PPO type Medicare Advantage plans for Medicare beneficiaries who are also on Medicaid. Because Medicaid is a state based program geared towards helping those that are low-income, these plans coordinate your Medicare and Medicaid to drastically reduce or even eliminate the costs of Part A and Part B covered services like copayments, deductibles, and premiums. The amount of cost reduction depends on the level of Medicaid you qualify for.
These plans often include the additional benefits included in other HMO plans (Vision, Dental, Hearing, Private Transportation, Acupuncture, Chiropractic, Fitness Memberships etc) and can even include an increased allowance or credit for certain benefits like Over-the-Counter health items in order to help low-income individuals get access to daily preventive care.
These plans require the individual to keep both their Medicare and Medicaid active to qualify, meaning that the individual will have to ensure payment for their Medicare Part A and Part B (**Medicaid may pay for the monthly Medicare Part A and Part B premiums**) as well as complete the necessary Medicaid re-certifications.
Dual Special Needs Plans | Chronic Special Needs Plans | Institutional Special Needs Plans
Chronic Special Needs Plans (C-SNP)
Medicare Advantage Chronic Special Needs plans are an HMO or PPO type of plan specifically for individuals with certain diagnosed chronic health conditions. These plans help by providing tailored benefits, special networks of doctors and a specific drug formulary in order to meet the unique needs of an individual with a chronic condition. These plans often also include access to a case management system and care coordinator dedicated to helping the individual maintain their health, help with specific needs, and even provide access to special local community resources available to the individual.
To qualify for a chronic special needs plan, an individual must be diagnosed with the following:
Chronic alcohol and other dependence
Autoimmune disorders
Cancer (excluding pre-cancer conditions)
Cardiovascular disorders
Chronic heart failure
Dementia
Diabetes mellitus
End-stage liver disease
End-Stage Renal Disease (ESRD) requiring dialysis (any mode of dialysis)
Severe hematologic disorders
HIV/AIDS
Chronic lung disorders
Chronic and disabling mental health conditions
Neurologic disorders
Stroke
Some plans in your area may only offer coverage for chronic conditions like diabetes or heart conditions, so it’s important to understand what options are available to you. Our ‘Even Better’ Medicare plan experts can easily help you find which plans are available in your area!
Dual Special Needs Plans | Chronic Special Needs Plans | Institutional Special Needs Plans
Institutional Special Needs Plans (I-SNP)
Medicare Advantage Institutional Special Needs Plans are HMO or PPO type plans specifically for those who have have had or who are expected to need care in any of the following institutions for 90 or more days: Long-term care facility (LTC), skilled nursing facility (SNF), a LTC nursing facility (NF), a SNF/NF, an intermediate care facility for individuals with intellectual disabilities (ICF/IDD) or an inpatient psychiatric facility.
Enrollment depends on the state assessing the official institutional level of care (LOC) needed.
Dual Special Needs Plans | Chronic Special Needs Plans | Institutional Special Needs Plans