what health condition qualify for special medicare plans

^{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
HIV/AIDS
Chronic lung disorders
Chronic and disabling mental health conditions
Neurologic disorders
Stroke

Do I qualify for Medicare special needs plans?

To be eligible to join a Medicare Special Needs Plan, you must be enrolled in Medicare Part A and Part B, reside in the plan’s service area and meet specific medical requirements. Seniors with a disabling chronic condition or who live in a nursing home, require in home care or currently receive both Medicare and Medicaid benefits may qualify.

What are special circumstances for Medicare Advantage?

Special circumstances (Special Enrollment Periods) You can make changes to your Medicare Advantage and Medicare prescription drug coverage when certain events happen in your life, like if you move or you lose other insurance coverage. These chances to make changes are called Special Enrollment Periods (SEPs).

Are you eligible for a Medicare SNP?

You also must live in the plan's service area. Then, you may be eligible if at least one of these is true for you: You have one or more severe or disabling chronic conditions. You live in a nursing home or need nursing care at home. You have Medicare and Medicaid. A Medicare SNP combines hospital, medical, and prescription drug benefits.

What do Medicare enrollees need to know about chronic conditions?

Approximately two-thirds of Medicare enrollees have multiple chronic conditions requiring coordination of care among primary providers, medical and mental health specialists, inpatient and outpatient facilities, and extensive ancillary services related to diagnostic testing and therapeutic management.

Who is eligible for C SNP?

C-SNPs are a type of Medicare Advantage (Part C) plan. 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.

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 a Medicare specialty 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 Medicare Dsnp?

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.

What is a FIDE SNP plan?

FIDE-SNPs are a type of Dual Eligible Special Needs Plan (D-SNP)3 offered by Medicare Advantage (MA) plans. They provide all Medicare and Medicaid services under one entity, and some provide long-term services and supports (LTSS). In 2019, 10 percent of all D-SNPs were FIDE-SNPs (45 of 445 plans).

Which is the special group that requires states to pay Medicare premiums deductibles and coinsurance?

Medicare Beneficiaries—Medicaid pays Medicare premiums, deductibles and coinsurance for Qualified Medicare Beneficiaries (QMB)—individuals whose income is at or below 100% of the Federal poverty level and whose resources are at or below twice the standard allowed under SSI.

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.

Are SNP plans network based?

SNP networks vary in size and the populations they serve. Two types of networks include: Networks covering a specified area. For example, one network may cover an entire state, while another network covers one county.

What levels of Medicaid dual eligibility usually qualify for a D-SNP select all that apply?

Dual-eligibles, individuals of any age who are eligible for both Medicare and Medicaid, qualify for D-SNPs. To be eligible for Medicare, individuals must be 65 years old or older or have a qualifying disability....Who Qualifies for D-SNPs?Type of D-SNPWho's Eligible to EnrollAll-DualAny dual-eligible beneficiary4 more rows

Which consumer may be a good candidate for a Dsnp?

A good candidate for a D-SNP meets the eligibility requirements for both Medicare and Medicaid. Those over 65 who are not on Medicaid but receive Extra Help or state assistance are also good D-SNP candidates.

What is the difference between Dsnp and MMP?

This includes providing beneficiaries with a seamless enrollment and disenrollment process and access to high-quality integrated healthcare. MMPs differ from SNPs in that they are a totally aligned product designed to further strengthen the coordination of Medicare and Medicaid Services.

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 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 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 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.

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.

Do you need a referral to see a specialist?

You may have to pick a primary care doctor and may need a referral to see a specialist. And most of the time you will have to use doctors, hospitals, and other providers in the network. Emergencies are an exception. Find a Medicare Plan that Fits Your Needs Get a Free Medicare Plan Review.

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.

What Is a Medicare Special Needs Plan and How Much Does It Cost?

Treatment of certain chronic health conditions such as cancer or dementia may require additional services above and beyond that which Medicare provides. For many seniors, extra cost associated with treatment is a burden and Special Needs Plans address these concerns.

Eligibility Requirements

To be eligible to join a Medicare Special Needs Plan, you must be enrolled in Medicare Part A and Part B, reside in the plan’s service area and meet specific medical requirements. Seniors with a disabling chronic condition or who live in a nursing home, require in home care or currently receive both Medicare and Medicaid benefits may qualify.

What Qualifies as a Chronic Condition?

Many seniors face chronic health conditions with age. However, to qualify for a Special Needs Plan, seniors must have one or more of the following chronic conditions:

What is a Medicare Special Needs Plan?

A Medicare Special Needs plan is a type of Medicare Advantage Plan available only to people who have certain qualifying health conditions or situations.

Who can join an SNP?

Anyone who is eligible for Medicare Part A (hospital insurance) and Medicare Part B (medical insurance), lives in the plan’s service area, and meets the plan’s eligibility requirements can join an SNP.

What are the different types of SNP plans and eligibility requirements?

There are several kinds of SNPs, and to be eligible to sign up, enrollees must meet the qualifications for at least one of these:

How does a Medicare SNP work?

Medicare SNPs must provide you with the same benefits as Original Medicare, but they usually offer more help and covered benefits than Original Medicare or other Medicare Advantage plans. This additional care includes:

How much do SNP plans cost?

That depends. SNPs generally don’t cost more than other Medicare Advantage plans. But because some SNPs offer additional care, they may charge a monthly premium in addition to the base premium.

Can I get my healthcare from any doctor or network?

Usually, you need to stay in the Medicare SNP network, which is generally geared toward your specific needs or condition. There are two exceptions, however:

What questions should I ask before I enroll in an SNP?

Just as you would before joining any plan, your questions should be geared toward your individual needs. Here are some examples of things to ask to help you narrow down your choices.

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.

What can I do with my Medicare Advantage Plan?

What can I do? Join a Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan. Switch from your current plan to another Medicare Advantage Plan with drug coverage or a Medicare Prescription Drug Plan. Drop your Medicare Advantage Plan with drug coverage and return to Original Medicare .

What to do if you made wrong choice on Medicare?

Call center representatives can help you throughout the year with options for making changes.

What is a special enrollment period?

Special circumstances (Special Enrollment Periods) You can make changes to your Medicare Advantage and Medicare prescription drug coverage when certain events happen in your life, like if you move or you lose other insurance coverage. These chances to make changes are called Special Enrollment Periods (SEPs).

When does Medicare change coverage?

You can’t use this Special Enrollment Period from October–December. However, all people with Medicare can make changes to their coverage from October 15–December 7, and the changes will take effect on January 1.

What is the difference between Medicare and Original Medicare?

Original Medicare. Original Medicare is a fee-for-service health plan that has two parts: Part A (Hospital Insurance) and Part B (Medical Insurance). After you pay a deductible, Medicare pays its share of the Medicare-approved amount, and you pay your share (coinsurance and deductibles).

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 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.

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.

When Can I Enroll in a C-SNP?

If you meet the eligibility requirements for a C-SNP, you can enroll at any time. This is known as a Special Enrollment Period. If you are newly diagnosed or have a worsening condition that makes you eligible for a C-SNP, you don’t have to wait for specific Medicare enrollment periods to join a plan.

Key Takeaways

Medicare SNPs are a type of Medicare Advantage plan that limits membership to people with a characteristic or condition in common.

What Does SNP Mean?

If you’re eligible for Medicare, you may have the option to enroll in a Special Needs Plan (SNP). So what does SNP stand for? In Medicare, SNP stands for Special Needs Plan.

What Are the 3 Types of Special Needs Plans?

There are three distinct types of SNPs. Each one addresses specific health or financial concern and aims to provide Medicare-eligible people with optimum care and support.

What is a Medicare Dual Special Needs Plan?

A Medicare Dual Special Needs plan is simply an abbreviated way of referring to a Medicare Dual Eligible Special Needs Plan (D-SNP). D-SNPs are for people already enrolled in both Medicare and Medicaid. D-SNPs provide comprehensive health coverage that combines the benefits of Medicare and Medicaid in one plan.