Chronic Condition Special Needs Plans (C-SNP) There are 15 different health conditions that may have a corresponding Medicare Special Needs Plan: Chronic alcohol and drug dependence Certain autoimmune disorders Cancer (excluding pre-cancer conditions or in-situ status) Certain cardiovascular disorders Chronic heart failure Dementia Diabetes mellitus End-stage liver disease End-stage renal disease requiring dialysis Certain severe hematologic disorders HIV/AIDS Chronic lung disorders Chronic and disabling mental health conditions Neurologic disorders Stroke
- Chronic alcohol and drug dependence
- Certain autoimmune disorders
- Cancer (excluding pre-cancer conditions or in-situ status)
- Certain cardiovascular disorders
- Chronic heart failure
- Dementia
- Diabetes mellitus
- End-stage liver disease
- End-stage renal disease requiring dialysis
- Certain severe hematologic disorders
What are Medicaid special needs plans?
- Polyarteritis nodosa
- Polymyalgia rheumatica
- Polymyositis
- Rheumatoid arthritis
- Systemic lupus erythematosus
What is Medicare Advantage special needs plan?
Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage Plan that serve individuals with chronic or disabling conditions. These plans require eligible patients to receive care and services from doctors or hospitals in their Medicare SNP networks. SNP networks vary in size and the populations they serve.
What is chronic condition special needs plan?
There are three types of Special Needs Plans (SNPs) available: Chronic-Condition Special Needs Plans (C-SNP): These plans serve beneficiaries with certain severe or disabling chronic conditions, such as cancer, chronic health failure, or HIV/AIDS.
What are dual eligible special needs plans?
- Interdisciplinary care team
- Provider network with specialized expertise to address needs of target population
- MOC quality improvement plan
- Measurable goals and outcomes for MOC
- SNP member satisfaction measure
- Ongoing performance improvement evaluation of the MOC
- Dissemination of SNP quality performance related to the MOC
What are the three types of Medicare special needs plans?
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 qualifies 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 does PPO SNP mean?
Preferred Provider OrganizationSNPs are also required to provide Part D coverage. Benefits access basics. Your Medicare SNP may be a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO). Depending on your plan, you may need to see in-network providers to receive coverage, or have the option of going out of network.
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.
What does HMO D SNP mean?
Dual Eligible Special Needs PlansDual 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 Dsnp and CSNP?
Overview. MedStar Medicare Choice Dual Advantage (HMO SNP, known as DSNP) and MedStar Medicare Choice Care Advantage (CSNP) are Medicare Special Needs Plans (SNP) that provide medical and prescription drug benefits to eligible beneficiaries.
What are dual special needs plans Dsnp?
What is a Dual Special Needs Plan (D-SNP)? A dual special needs plan is a type of health insurance plan. It's for people who have both Medicaid and Medicare. If that's you, you're “dual-eligible.” (That's just another way of saying you can have Medicaid and Medicare at the same time).
What is the purpose of the chronic condition verification form?
What is the purpose of the Chronic Condition Verification form? It authorizes the plan to contact the provider identified on the form in order to verify that the consumer has at least one of the qualifying chronic conditions covered by the CSNP.
Do doctors prefer HMO or PPO?
PPOs Usually Win on Choice and Flexibility If flexibility and choice are important to you, a PPO plan could be the better choice. Unlike most HMO health plans, you won't likely need to select a primary care physician, and you won't usually need a referral from that physician to see a specialist.
What are some distinct advantages of a SNP plan?
SNPs provide helpful guidance and resources to members based on their specific condition or needs. The plan may offer extra benefits tailored to the groups it serves, such as diabetes services, care coordination or other health and wellness programs.
What are some distinct advantages of a dual special needs plan?
Dual plans offer extra benefits and features at no extra costDental care, plus credit for restorative work.Eye exams, plus credit for eyewear.Hearing exams, plus credit for hearing devices.Rides to health care visits and the pharmacy.Credits to buy hundreds of health-related products.
CHRONIC SPECIAL NEEDS PLAN (C-SNP)
Chronic conditions aren’t always catered for by regular Medicare plans.
ELIGIBILTY AND BENEFITS
The eligibility criteria for C-SNP includes – those enrolled in Medicare Part A and Part B (You can, however, sign up for Medicare Advantage plan straight from the government instead of getting Medicare Part A and B).
MEDICARE ADVANTAGE PLANS FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
COPD is a group of diseases that affects the respiratory system. they cause breathing problems like; emphysema. Chronic bronchitis, and asthma. A key causative factor in the United States is Smoking, with 1 in 9 Medicare beneficiaries diagnosed with COPD and Medicare paying 51% of all US direct health care costs for COPD.
MEDICARE ADANTAGE PLANS FOR HEART DISEASE
Medicare provides coverage for a wide variety of heart disease screenings, rehabilitation and behavioral training.
SPECIAL ENROLLMENT PERIOD (SEP) FOR C-SNP
Whenever certain circumstances occur that alter your healthcare coverage, you may have a chance to make changes to your Medicare Advantage plan. These chances to make changes are called Special Enrollment Periods (SEPs).
Where to find special needs plan?
For a full list of conditions, go to Medicare.gov and search “special needs plan."
What is a chronic condition SNP?
How to Sign Up for a Medicare SNP. When to Enroll in an SNP. What Else You Should Know. If you have a chronic condition, you may be able to get a special Medicare plan called a special needs plan (SNP). It's a type of Medicare Advantage Plan that is limited to people with certain diseases ...
What is Medicare SNP?
A Medicare SNP combines hospital, medical, and prescription drug benefits. That makes it easier to coordinate all the parts of your care, makes it easier to follow your doctor’s advice for diet and prescriptions, and can help you get help from the community.
What are some examples of chronic conditions that SNPs cover?
Those are among the 15 chronic conditions that SNPs cover. Other examples are autoimmune disorders, diabetes, dementia, lung disease, and end-stage liver and kidney diseases. A SNP may focus on one chronic condition or several.
What does SNP do for congestive heart failure?
If you have congestive heart failure, your SNP might offer special programs to manage care for people with congestive heart failure. It also might help you find doctors who specialize in treating it. You also may have a care coordinator.
Does Medicare SNP include drug coverage?
If you have Medicare and Medicaid, a Medicare SNP can help coordinate them. You won't need extra drug coverage. Medicare SNPs include drug coverage. That means you do not need Part D, Medicare's prescription drug plan. You may not need other insurance. You may have had Medicare supplemental insurance called Medigap.
Is Medicare SNP a single plan?
All of your medical services are provided through a single plan. Once you are enrolled in a plan, before you receive a service, it is important to make sure the SNP plan covers the services you need. If you are not sure, you can ask the plan for a decision in advance to make sure the service is covered. A Medicare SNP is designed just for you.
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:
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 MIPPA for SNP?
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. MIPPA further extended the SNP program through December 31, 2010, thereby allowing CMS to accept MA applications for new SNPs and SNP service area expansions until CY 2010. CMS accepted SNP applications from MA applicants for creating new SNPs and expanding existing CMS-approved SNPs for all three types of specialized SNPs in accordance with additional SNP program requirements specified in MIPPA. CMS regulations that implement and further detail MIPPA application requirements for SNPs are located at 42 CFR 422.501-504.
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) ...
When did the SNP program end?
Most recently, section 206 of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) extended the SNP program through December 31, 2018.
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.
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.
How Medicare Special Needs Plans work
Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage Plan. All Medicare Advantage plans must cover the same Medicare services. But some Medicare SNPs are for people with specific diseases or challenges. These plans may tailor benefits, doctors and drug choices to match the needs of the groups they serve.
The 4 types of Medicare Special Needs Plans
Dual Special Needs Plans (D-SNPs) are for people who have both Medicare and Medicaid. (These people are also known as “dual-eligible.”)
What Do Special Needs Plans Cost?
If you are Medicare dual-eligible, some of the costs to join a D-SNP (such as premiums and deductibles) may be covered for you.
How to qualify for a special needs plan?
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 dual-eligible. Reside in the plan’s service area. A Chronic Condition SNP will require a note ...
What Do Medicare SNPs Cover?
Like all Medicare Advantage plans, Special Needs Plans will provide all of the same coverage as Medicare Part A and Part B.
What is a SNP plan?
Your Complete Guide to Medicare Special Needs Plans (SNP) A Medicare Special Needs Plan (SNP) is a type of Medicare Advantage plan (Medicare Part C) that is designed to fit the health care needs of people with a certain health condition or circumstance.
When does Medicare AEP take place?
The Medicare AEP takes place every year from October 15 to December 7. Special Enrollment Period (SEP) You may be granted a Special Enrollment Period at any time throughout the year, depending on your circumstances.
When does Medicare enroll in AEP?
Annual Enrollment Period (AEP) The Medicare AEP takes place every year from October 15 to December 7.
What is a care coordinator in Medicare?
A care coordinator is a type of personal health care assistant who helps you schedule appointments, adhere to your doctor-recommended diet and exercise plan, obtain the right prescriptions, access community resources and more.
What is a C-SNP Medicare Plan?
C-SNP Medicare plans are required to cover at least as much as Original Medicare (Part A and Part B). This includes hospitalizations, medical care and preventive care.
What is a C SNP?
C-SNP stands for Chronic Condition Special Needs Plan. C-SNPs are a special type of Medicare Advantage (Part C) plan. Because of the plan’s targeted care, eligible members typically have medical conditions or characteristics in common. If you have a chronic, long-term health condition such as diabetes, dementia or heart disease , you may benefit from having an insurance plan geared specifically towards your unique needs.
What is Medicare Advantage?
Medicare Advantage ( Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D).
How long does it take to get Medicare?
Initial Enrollment Period: If you are newly qualified for Medicare due to age, initial enrollment begins three months before your 65th birthday and ends three months after your 65th birthday, for a total of seven months (or four months before and two months after if your birthday is on the first day of the month).
What are the benefits of having a C-SNP?
The benefits of having a C-SNP include access to hospitals and medical professionals who specialize in your condition or disease. C-SNPs also use drug formularies geared towards the needs of its membership.
When is the election period for C-SNP?
Annual Election Period: Your Annual Election Period takes place each year from Oct. 15 to Dec. 7. During this period, you can switch from an existing plan or enroll in a C-SNP for the first time. You can also disenroll from your plan during this time.
Do you have to be eligible for Medicare for C-SNP?
To be eligible for a C-SNP, you must also be eligible for Medicare.
***NEW*** Request For Information
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 adver...
Grouping Chronic Conditions
- When completing the SNP application, MAOs may apply to offer a C-SNP that targets any one of the following: 1. A single CMS-approved chronic condition (selected from the list above), 2. A CMS-approved group of commonly co-morbid and clinically-linked conditions (described below), or 3. An MAO-customized group of multiple chronic conditions (described below).