In order to qualify for a Special Needs Plan, you must meet each of the following criteria:
- Be enrolled in Medicare Part A and Part B
- Have one of the chronic conditions above, reside in a nursing home or require home nursing care or be Medicare...
- Reside in the plan’s service area
Full Answer
How do I qualify for a Medicare special needs plan?
In order to qualify for a Special Needs Plan, you must meet each of the following criteria: 1 Be enrolled in Medicare Part A and Part B 2 Have one of the chronic conditions above, reside in a nursing home or require home nursing care or be Medicare dual-eligible 3 Reside in the plan’s service area
What is a Medicare Advantage special needs plan?
Medicare Advantage special needs plans focus on coordinating care for three different groups: people with specific chronic illnesses, people who qualify for both Medicare and Medicaid, or people who need institution-level nursing care. Membership is limited to people with these conditions or in these situations.
How do I qualify for an institutional special needs plan?
To qualify for an Institutional Special Needs Plan, you must live in a long-termin long-term care facility served by the SNP for a minimum of 90 days. The facility can be either a nursing home or an intermediate care facility for those with intellectual disabilities.
What is a Medicare SNP and who is eligible?
Some Medicare SNPs are designed for people who are dual-eligible, meaning they are eligible for both Medicare and Medicaid. What does a Medicare SNP cover? Each Medicare SNP is designed to offer some unique benefits designed to serve the population for whom that plan is designed.
What are the three types of special needs plans for Medicare?
There are three different types of SNPs:Chronic Condition SNP (C-SNP)Dual Eligible SNP (D-SNP)Institutional SNP (I-SNP)
What is an SNP Medicare plan?
Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.
What is HMO SNP mean?
A Special Needs Plan (SNP) is a type of Medicare Advantage plan that combines all the benefits of Original Medicare (Parts A and B) with prescription drug coverage (Part D), but is only available to those beneficiaries who have an additional qualifying condition.
Who is eligible for a CSNP?
To be eligible for a C-SNP, you must also be eligible for Medicare. C-SNPs are designed to provide people with chronic or debilitating illnesses the medical care and treatments they need, all in one plan. C-SNPs always include prescription drug coverage (Medicare Part D).
What is a dual eligible Special Needs Plan D-SNP )?
Dual Eligible Special Needs Plans (D-SNPs) enroll individuals who are entitled to both Medicare (title XVIII) and medical assistance from a state plan under Medicaid (title XIX). States cover some Medicare costs, depending on the state and the individual's eligibility.
What is the difference between SNP and D-SNP?
Institutional SNP (I-SNP): For those who live in an institution such as a nursing home or require nursing care at home. Dual-Eligible SNP (D-SNP): For those with both Medicare and Medicaid.
Is D-SNP a Medicare Advantage Plan?
Dual Eligible Special Needs Plans (D-SNPs) are Medicare Advantage (MA) health plans which provide specialized care and wrap-around services for dual eligible beneficiaries (eligible for both Medicare and Medicaid).
What is a D-SNP look alike plan?
D-SNP “look-alike” plans (sometimes called “mirror” plans) are Medicare Advantage plans that plan sponsors have designed specifcally to attract dual eligible benefciaries.
What is an LPPO plan?
Generations Advantage Select (LPPO) is designed for those looking for a health care plan with more flexibility. With this plan, you get complete medical, hospital, and Part D Prescription Drug coverage and you can see out-of-network doctors for all covered medical services, though you pay less for in-network doctors.
What program supports CSNP and Dsnp?
Medicare Choice is committed to offering a Model of Care (MOC) that meets the unique needs of both DSNP and CSNP members.
How long do plans using the CSNP post enrollment verification process have to verify the qualifying chronic condition?
How long do plans using the CSNP pre-enrollment verification process have to verify the qualifying chronic condition until they must deny the enrollment request? Within 21 days of the request for additional information or the end of the month in which the enrollment request is made (whichever is longer).
What are the three types of Medicare special needs plan?
The three types of special needs plan serve different groups of people:
Who's eligible to join a SNP?
By law, Medicare SNPs are not available to just anybody. You can enroll in a SNP only if:
How are these plans different from typical Medicare Advantage plans?
All Medicare Advantage plans provide hospitalization benefits and coverage of necessary medical services; some plans — including some SNPs — also offer vision, hearing, and dental care. But SNPs are different, because their benefits are specifically focused on plan members’ personal circumstances.
How much do Medicare special needs plans cost compared to original Medicare?
The cost of an SNP, as with all Medicare Advantage plans, reflects its plan type and benefits.
How do you enroll in a Medicare special needs plan?
Normally, if you meet the requirements for a SNP, you can join it during the regular Medicare Advantage open enrollment period from January 1 to March 31 each year. However, the situation that made you eligible for the SNP may also qualify you to have a special enrollment period (SEP).
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The bottom line
Medicare Advantage special needs plans focus on coordinating care for three different groups: people with specific chronic illnesses, people who qualify for both Medicare and Medicaid, or people who need institution-level nursing care. Membership is limited to people with these conditions or in these situations.
How to qualify for Medicare?
To qualify, you must have one of these three characteristics: 1 You have a chronic condition such as diabetes, heart disease, or one of 13 other ailments determined by the Centers for Medicare and Medicaid Services. 2 You can join a Chronic Condition Special Needs Plan, or C-SNP. 2 You have both Medicare and Medicaid. People who meet this qualification are referred to as “dual-eligibles” and can join plans called Dual Eligible Special Needs Plans, or D-SNPs. Not sure what the difference is? Compare Medicare vs. Medicaid. 3 You live in an institution such as a nursing home, or you require that level of care at home. You can join an Institutional Special Needs Plan, or I-SNP.
What is a SNP plan?
What is a Special Needs Plan (SNP)? Special Needs Plans are one way to receive your Medicare coverage. SNPs are a type of Medicare Advantage plan, which is a health plan offered by a private insurance company that has contracted with Medicare. Medicare Advantage plans are sometimes called Part C.
What does SNP cover?
SNPs typically cover the following: Care and services from providers in the SNP network. In most SNPs, you’ll choose a primary care doctor who will coordinate your care and give you referrals to specialists when needed. However, you can go outside the network for emergencies and urgent care needs. Prescription drugs.
Does SNP cover Medicare?
Like all Medicare Advantage plans, SNPs must cover the same services as Original Medicare (Parts A and B). So SNPs can’t cover any less than what Original Medicare does, and usually they cover more. SNPs typically cover the following: Care and services from providers in the SNP network. In most SNPs, you’ll choose a primary care doctor who will ...
Can you get a special needs plan with Medicare?
Not everyone who meets the eligibility requirements for Medicare is eligible for a Special Needs Plan. To qualify, you must have one of these three characteristics: You have a chronic condition such as diabetes, heart disease, or one of 13 other ailments determined by the Centers for Medicare and Medicaid Services.
Is a SNP a PPO?
Like HMOs and PPOs, SNPs are a type of Medicare Advantage plan. However, SNPs are defined by who they serve, while HMOs and PPOs are defined by the types of provider networks they have and how you access them. So, a plan can be both an SNP and an HMO or PPO. 3.
SNPs are part of Medicare Advantage
Special needs plans are Medicare Advantage plans tailored for specific medical concerns.
SNPs limit enrollment and benefits around specific concerns or chronic condition
A SNP provides a specific list of available providers and services, depending on the Medicare beneficiary's condition. For example, if you have an autoimmune disorder or a mental health condition, your SNP could cover services like home health care or behavioral health services.
If you need long-term nursing care, you might qualify for a SNP
If you’re planning to receive long-term nursing care, whether at home or in a facility, you may qualify for an SNP. You also qualify if you receive both Medicare and Medicaid services or if you have any chronic conditions, including chronic heart disease or diabetes, that require long-term care. According to The Official U.S.
What is Medicare Advantage Special Needs?
Medicare Advantage Special Needs Plans can also cater more specifically to the needs of people with: There also Special Needs Plans that can be available to people who reside in a long-term care facility such as a skilled nursing home.
What is a special needs plan?
A Special Needs Plan is a type of Medicare Advantage plan (also called Medicare Part C) that is designed specifically for someone with a particular disease or financial circumstance. The coverage offered by each SNP is built around providing more narrowly-focused care that better meets the needs of the patient.
What is a SNP plan?
A Medicare SNP, or Special Needs Plan, is a type of Medicare Advantage plan tailored to the needs of specific health conditions or circumstances. Learn more about what a Medicare Advantage SNP might cover, how these plans typically work and how and when you can enroll in an SNP plan. Medicare Advantage plans called Special Needs Plans (SNP) ...
What is Medicare Advantage?
Medicare Advantage plans offer an alternative way to receive Original Medicare benefits (Part A and Part B), and many Medicare Advantage plans offer additional benefits that aren't covered by Original Medicare. Medicare Advantage plans come in a variety of types such as HMOs and PPOs. While Original Medicare can be used all over the country, ...
What is a SNP in Medicare?
Each Medicare SNP is designed to offer some unique benefits designed to serve the population for whom that plan is designed. For example, a Medicare SNP for beneficiaries who have a chronic lung disorder may include: A network of providers who specialize in treating lung conditions.
Why are special needs plans beneficial?
Special Needs Plans can be particularly beneficial because of their focused coverage benefits. Care coordination. Some Special Needs Plans feature care coordination services. These plans may assign a care coordinator to each member who serves as a sort of "quarterback" for your care.
When is the SNP open enrollment period?
You may enroll in a Medicare SNP during the annual Medicare Open Enrollment Period that runs from October 15 to December 7 every year. You may also enroll in a Medicare SNP if you are granted a Special Election Period. You may be given a Special Election Period if:
What is a special needs plan?
A special needs plan (SNP) is a Medicare Advantage (MA) coordinated care plan (CCP) specifically designed to provide targeted care and limit enrollment to special needs individuals. A special needs individual could be any one of the following: An institutionalized individual, A dual eligible, or. An individual with a severe or disabling chronic ...
Why do SNPs need to provide Part D coverage?
All SNPs must provide Part D prescription drug coverage because special needs individuals must have access to prescription drugs to manage and control their special health care needs. SNPs should assume that, if no modification is contained in guidance, existing Part C and D rules apply.
What is SNP in healthcare?
A SNP may be any type of MA CCP, including either a local or regional preferred provider organization (i.e., LPPO or RPPO) plan, a health maintenance organization (HMO) plan, or an HMO Point-of-Service (HMO-POS) ...
Do SNPs have to submit bids?
SNPs must prepare and submit bids like other MA plans, and are paid in the same manner as other MA plans based on the plan’s enrollment and risk adjustment payment methodology. All SNPs must abide by current CMS guidance on cost sharing requirements.
Do SNPs have to follow Medicare?
SNPs are expected to follow existing MA program rules, including MA regulations at 42 CFR 422, as modified by guidance, with regard to Medicare- covered services and Prescription Drug Benefit program rules. All SNPs must provide Part D prescription drug coverage because special needs individuals must have access to prescription drugs to manage and control their special health care needs. SNPs should assume that, if no modification is contained in guidance, existing Part C and D rules apply.
Did CMS accept SNP applications in 2008?
Accordingly, CMS did not accept SNP applications in 2008 for contract year (CY) 2009. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) lifted the Medicare, Medicaid, and SCHIP Extension Act of 2007 moratorium on approving new SNPs.
How to qualify for dual SNP?
To qualify for a Dual Eligible Special Needs Plan, you need to provide proof that you have Medicaid. This can be accomplished either by producing a letter from Medicaid or showing your Medicaid identification card. Alternatively, you can complete the enrollment form for the D-SNP and the plan administrator will verify your Medicaid status. It is important to note that if you are enrolled in a Medicare MSP (Medical Savings Plan) at the time that you apply for a Dual Eligible Special Needs Plan, you may find that the specific plan does not accept MSP beneficiaries to enroll. Most D-SNPs include a high level of dental, vision, and hearing care, as well as many other benefits.
How long do you have to live in a nursing home to qualify for SNP?
To qualify for an Institutional Special Needs Plan, you must live in long-term care served by the SNP for a minimum of 90 days. To qualify, the facility can be either a nursing home or an intermediate care facility for those with intellectual disabilities. Alternatively, you must have met your state’s guidelines for requiring a nursing home-level of care for a minimum of 90 days whether you live in a community setting such as your home or a group residence or in an institution. Those who have not yet received care for at least 90 days but who are likely to need that level of care for that period of time can also qualify.
Why is Medicare SNP important?
Because Medicare SNP plans are created with special needs in mind, they generally go beyond providing the same level of coverage as Original Medicare Parts A and B, offering benefits that are specifically tailored to their enrollees’ conditions or circumstances . The targeted services that are offered are formulated to complement the regimens and requirements of the beneficiaries. This both improves treatment and minimizes frustrations and costs that may be encountered in other Medicare Advantage plans that serve a more general patient population.
What are the drawbacks of Medicare SNP?
Though Medicare SNP plans are designed to provide special services to those Medicare beneficiaries that need them, there are some drawbacks to the programs. The SNP plans frequently require their enrollees to see physicians and use providers that are part of pre-established networks, and this may preclude you from remaining with your existing physician. You also may need to get referrals to see specialists. The programs are not widely available, and those who believe they are qualified in the programs must meet specific SNP eligibility criteria. Beneficiaries may be disenrolled when their status changes and they no longer meet the criteria, and will then need to enroll in another plan. Though, if a beneficiary is disenrolled they will have a Special Enrollment Period to join another Medicare Advantage plan.
List of Chronic Conditions
Section 1859 (b) (6) (B) (iii) of the Act and 42 CFR 422.2 define special needs individuals with severe or disabling chronic conditions as special needs individuals “who have one or more co-morbid and medically complex chronic conditions that are substantially disabling or life threatening; have a high risk of hospitalization or other significant adverse health outcomes; and require specialized delivery systems across domains of care.” CMS solicited public comments on chronic conditions meeting the clarified definition and convened the SNP Chronic Condition Panel in the fall of 2008.
Grouping Chronic Conditions
When completing the SNP application, MAOs may apply to offer a C-SNP that targets any one of the following:
CMS-Approved Group of Commonly Co-morbid and Clinically-Linked Conditions
A C-SNP may not be structured around multiple commonly co-morbid conditions that are not clinically linked in their treatment because such an arrangement results in a general market product rather than one that is tailored for a particular population.
