What Is a Medicare Special Needs Plan?

Posted by Bryce Korngold
Estimated Reading Time 1 minute 46 seconds

While Original Medicare covers a variety of healthcare costs, there are circumstances when some patients need additional coverage or support. If you have any special medical situations, it’s a good idea to talk to an insurance expert about specialized care available through Medical Special Needs Plans (SNPs).

How Medicare Special Needs Plans Work

SNPs are custom-designed to ensure appropriate support for patients with unique health conditions. The focus is on designing the ideal plan network, prescription drug formulary, and benefits. Additionally, SNPs help patients manage these health conditions through one-on-one support from care coordinators, with the plan structure to match doctor’s orders and access available community resources.

If you become eligible for an SNP any time during the year, then there is a window of time (known as a Special Enrollment Period) when you can choose an SNP.

Do You Quality for a SNP?

How do you know if you qualify for a Medicare SNP? Talk to your doctor and insurance agent for more information. To qualify for these Medicare plans, patients must be diagnosed with specific chronic illnesses. These are some of the conditions that might permit you for coverage:

• Lung disorders (such as COPD)
• Cancer
• End-stage renal disease requiring dialysis
• Hematologic disorders
• Disabling mental illness
• Autoimmune disorders
• HIV or AIDS
• Alzheimer’s or dementia
• Cardiovascular disease, stroke, or chronic heart failure
• Diabetes
• Neurologic conditions

Institutional SNPs are available for people who can’t live independently. For example, if it’s expected that someone will need to be institutionalized for 90 days or more, then the patient might qualify for a unique type of SNP.

Additionally, eligibility requirements vary based on geographical area. Private insurance companies determine where certain types of plans are available. As a result, some patients living with chronic conditions might not be able to access a plan in the local area that fits their needs. If you move to a different location, then it could impact your eligibility.

Personalized Considerations for Medicare Coverage

Many factors affect eligibility, pricing, and access to different types of Medicare coverage. The insurance industry can be confusing to navigate, which is why it’s wise to reach out to a qualified insurance provider for personalized support.

For example, you must be enrolled in Original Medicare, and there will be a separate premium for the SNP. Your insurance agent can help you review coverage availability and out-of-pocket costs for deductibles and co-pays based on the plan you choose.

Call us at Monarch Benefits to speak with a licensed agent to learn more about your options.