How to join a Medicare Advantage SNP
Medicare Advantage Special Needs Plans
Medicare Advantage (Part C) Special Needs Plans (SNP) are available to Medicare beneficiaries who have certain health conditions or who are also covered by Medicaid. If you fall under this category, you may have specific health care needs for which you use certain medical services regularly. For example, if you have diabetes, you will need a health benefits plan that includes coverage for blood sugar testing supplies, insulin, any medications used to treat diabetes, plus regular checkups with your diabetes doctor, a podiatrist, vision care professional or other specialists to monitor for medical conditions that can be associated with diabetes. The Medicare Part C SNP includes coverage for all your hospital (Medicare Part A), medical health care services (Medicare Part B) and prescription drug (Medicare Part D) needs through one plan.
Like other Medicare Advantage Plans, Medicare Advantage SNPs are available through private insurance companies. Because of that, plan options and benefits can vary. Some plans even include care coordination services to help you understand your condition and stick to your doctor's treatment regimen. Or you might have access to wellness programs to help with your special diet or other lifestyle activities that can help improve your condition. It's important to note that you still get all the coverage that is otherwise included with Medicare Parts A, B and D. The special needs plan offers extra coverage to help you manage your health condition.
Who can join a Medicare Advantage SNP
You must live in the service area of the special needs plan that you are considering. You must also meet the eligibility criteria for that SNP. Examples of eligibility criteria include:
You have both Medicare and Medicaid.
You live in a nursing home or require at-home care.
You have the specific disease or condition for which the special needs plan is created (such as diabetes or congestive heart failure) and you already have Medicare or are newly eligible to join Medicare.
What you'll pay with a Medicare Advantage SNP
Depending on the plan, you may still need to pay your Medicare Part B premium in addition to the Medicare Part C SNP premium. You may even pay a separate premium for prescription drug benefits and extra benefits. You are also responsible for typical out-of-pocket costs associated with the plan. Those can include a deductible, coinsurance and copayments. Each plan is different so you should review the specific plan documents to see how much you pay. Pay particular attention to the differences in your cost sharing when you use the plan's network doctors versus out-of-network doctors (if the plan allows you to go outside the network).
Getting help with your costs
If you have both Medicare and Medicaid, or if you have limited income, Medicaid may be able to cover some or all of your plan's premiums and/or out-of-pocket costs. Call you state's Medical Assistance office or call 1-800-633-4227 for the phone number.
How to join a Medicare Advantage SNP
The enrollment period for Medicare Advantage SNP is the same as enrollment for any other Medicare Advantage (Medicare Part C) Plan. Initial enrollment is the seven month-period that starts three months before your 65th birthday or three months before the 25th month that you are receiving Social Security Disability benefits. Thereafter, you are elgible to enroll during the annual enrollment period.
There are also special enrollment periods for those who qualify. For example, if you already have Medicare and you are newly diagnosed with a qualifying health condition, you can join a SNP that supports that condition. Or, if your current SNP leaves your service area, or if you move out of the SNPs service area, you can switch to another plan if one is available.
Medicare Advantage SNPs are offered by private insurers who determine where to offer their plans. That means SNPs are not available everywhere.
(Information obtained from ehealthmedicare.com)