Medicare Advantage Special Needs Plans
It’s no secret that Medicare Advantage has the most comprehensive of all Medicare plans. But this fact can lend itself to the idea that Medicare Advantage is only affordable for a select few. In reality, that cannot be further from the truth. Medicare Advantage has plans for all people, regardless of physical condition or financial situation.
Medicare Advantage Special Needs Plans (SNPs) stand out as one of the best Medicare plans for those in adverse life circumstances.
What Do SNPs Consist Of?
SNPs consist of three types:
- Dual Eligible (D-SNP)
- Chronic and Disabling Condition (C-SNP)
- Institutional (I-SNP)
D-SNPs are for those who qualify for Medicare and Medicaid. This wraps the benefits of both into one policy, with reduced costs. D-SNPs optimize coordinated Medicare and Medicaid coverage.
C-SNPs provide special discounts for all treatments, services, and medications specifically used for treating a person’s condition. Qualifying conditions include HIV/AIDS, End-Stage Renal Disease (ESRD), and chronic heart failure.
I-SNPs are for those needing institutional care, such as that offered in a nursing home.
What Do SNPs Cover?
SNPs must cover everything that Original Medicare does, with added benefits (such as dental, vision, and hearing). This is also a plan that mandates prescription drug coverage. No matter the type of SNP you get or the insurer you obtain it from, your SNP coverage will include prescription medications.
Inpatient coverage includes the services you get when you are admitted in a hospital or other inpatient facility.
You will get coverage for outpatient services, such as preventive care services and durable medical equipment.
How Do They Work?
Some SNPs require you to get your treatments within your network. If you get a plan like this, you won’t be able to get coverage for non-emergency treatments outside of your plan’s network. If your specific plan allows for out-of-network treatment coverage, you will be able to get the treatment, albeit at a higher price.
You’ll need to choose a primary care physician, and you will need referrals to see specialists. Your primary care physician will then direct the course of your care and make decisions according to the state of your condition and how you respond to treatments.
What Should I Consider?
If you have a Medicare Advantage plan, you won’t be able to have other types of health insurance. This includes employer health coverage. You also cannot have a Medicare Supplement Plan if you are enrolled in Medicare Advantage.
Who Is It Right For?
SNPs are highly specialized and have the most restrictive eligibility criteria out of all plans. If you’re eligible for both Medicaid and Medicare, live in an institution, or have a chronic and disabling condition, an SNP would be the right plan for you.
We’re Here To Get You The Plan You Need
At Peritia Advisors, we will help you find the best SNP. We’re here so that you can find a plan that suits you, and one that gives you the benefits you need at the lowest price!
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