Medicare Special Needs Plans: Who Can Qualify?

Medicare Special Needs Plans, or SNPs, are Medicare Advantage plans that are specially designed for specific groups. In order to enroll in one, you will need to meet the eligibility requirements of the plan.

For those who qualify, these plans may provide convenient care options. In addition to covering all the services that other Medicare Advantage plans are required to cover, SNPs may provide additional coverage to meet the special needs of the group it serves. SNPs may also use a care coordinator who works with enrollees to make sure they’re getting the services and information they need. Additionally, all SNPs include prescription drug coverage, meaning you don’t have to worry about enrolling in a separate Medicare Part D plan that covers your prescriptions.

There are three types of SNPs: Chronic Condition SNPs, Dual Eligible SNPs and Institutional SNPs.

Chronic Condition SNPs

Chronic Condition SNPs, also called C-SNPs, cater to various chronic conditions. Different C-SNPs will cater to different conditions. For example, one C-SNP may be designed for people with chronic lung disorders, while another may be designed for people with cancer.

Other C-SNPs cater to the needs of people with alcohol dependence and other dependence, autoimmune disorders, cardiovascular disorders, chronic heart failure, dementia, diabetes mellitus, end-stage live disease, end-stage renal disease, severe hematologic disorders, HIV/AIDS, chronic and disabling mental health conditions, neurologic disorders and stroke.

If you have one of these conditions, check to see if there is a C-SNP available for it in your area.

Dual Eligible SNPs

Dual Eligible SNPs, also called D-SNPs, are designed for people who have both Medicaid and Medicare. If you are a Medicare enrollee who is also qualified for Medicaid, look for D-SNPs in your area.

Institutional SNPs

Institutional SNPs, also called I-SNPs, are designed for people living in an institution, such as a nursing home. I-SNPs are also available for people who require nursing care at home. If you live in a nursing home or require nursing care, or if you are helping a Medicare beneficiary who lives in a nursing home or requires nursing care, see if there are I-SNPs in your area.

Special Enrollment Periods

If you qualify for an SNP, you may not need to wait until the next fall open enrollment period to change your plan. If you qualify for a special enrollment period, you can enroll in an SNP anytime of the year. For example, if you are diagnosed with a chronic condition, and if there is an SNP tailored to that chronic condition where you live, you can use a special enrollment period to join. People who are eligible for Medicare and Medicaid also qualify for special enrollment periods during three different periods each year.

If you’re situation changes and you no longer qualify for the SNP, you will have to leave the plan. You will have a grace period of at least one month before you must leave the plan. You will be given a special enrollment period so you can enroll in a different plan.

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