Medicare Special Needs Plans (SNP) are primarily Medicare advantage plans like an HMO or PPO. These are custom-fit plans for people with specific disabilities, chronic diseases, or health characteristics in terms of benefits, health care provider options, and drug formularies. These plans must include the same services provided in Original Medicare Parts A and B. All SNP’s include Part D coverage.
The Medicare Special Needs plan is tailored to provide the maximum support to those people with specific health conditions and chronic illnesses. For instance, these plans offer access to providers who specialize in treating specific illnesses. These providers are coordinated and work together closely to give quality health care.
SNP plans mostly assign Caseworkers or Care Coordinators to assist members in managing health conditions, strictly following care providers’ orders, and generally keeping up with the member’s health condition. They also help members access community resources and closely monitor if members are getting the proper prescriptions. In terms of the Drug formulary, these plans offer a complete list of drugs in treating specific health conditions.
Types of Special Needs Plan
Chronic Illness SNP
For people with Chronic conditions to be able to avail these Medicare Special Needs Plans, they must have their care providers and doctors complete the chronic condition verification form upon enrollment. The forms shall be provided by the agent of choice to be given to the doctor, who can complete the form and return it to verify eligibility. It is important to note that Chronic Illness SNP plans vary by county. Insurance Carriers choose where they will offer specific plans. That means you may or may not have access to an SNP in your area that specializes your specific medical condition. Health Plans in Oregon can be of help for you to check what is offered.
Health Conditions Qualified for Chronic Illness SNP
- ESRD requiring dialysis
- Hematologic disorders
- Autoimmune disorders
- Alzheimer’s or Dementia
- Cardiovascular disease, stroke, or chronic heart failure
- HIV or AIDS
- Chronic lung disorders (like COPD)
Chronic or disabling mental illness
- Neurologic conditions
Institutional Special Needs Plan (ISNP)
Medicare members living in an institution – assisted living, memory care facilities, and nursing homes may also qualify for Medicare Special Needs Plans. These plans are the same as the chronic illness SNP but focus on providing coordinated care to someone who is not living independently. Note that the medicare member must be expected to live in the institution for at least 90 days.
Dual Eligible Special Needs Plan (DSNP)
Beneficiaries that are Dual Eligibles ( Medicare and Medicaid (Oregon Health Plan) are qualified. They can enroll in a Dual Eligible Special Needs Medicare Plan. One advantage of having this type of SNP is that members with full Medicaid can expect to spend a bit to nothing on deductibles, copays, and coinsurance for Part A and B services provided by the plan. These Dual SNP Plans also may offer additional benefits such as: dental, vision, hearing, over the counter items or healthy food allowance. Some plans have a $0 premium because Medicaid pays any plan premium for you. Those who have partial Medicaid may have to pay some cost-sharing.
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