WHAT IS A MEDICARE SPECIAL NEEDS PLAN?

The Medicare SNP’s……what is a Special Needs Plan ?      

Medicare Special Needs Plans (SNP) are Medicare Advantage 

(MAPD) Plans that are designed for specific Medicare Members that have lower income levels (D-SNP), chronic diseases (C-SNP), and/or require care from a Skilled Nursing Facility (I-SNP).   

*See also EXTRA HELP, bottom of page.

THERE ARE 3 TYPES of SNP’s:

•     Dual SNPs for people who qualify for both Medicare & Medicaid with lower incomes

•     Chronic Illness SNPs for people with an approved severe/disabling chronic condition

•     Institutional SNPs for people who reside in nursing homes in need of constant care

Seniors can join a Medicare SNP if the consumer has Medicare Part A & Part B, live in the plan's service area, and meet the plan's eligibility requirements, with any of the following:

•  Seniors that have one or more specific chronic or disabling conditions (like diabetes, congestive heart disease, cardiovascular disease, a  mental health condition, & others). OR>

•  Seniors living in an institution (like a nursing home), or the consumer requires nursing care at home. OR>

•  Senior having both Medicare and Medicaid or partial Medicaid. These are Dual-eligible members.

In a nutshell, SNPs provide help for the economically disadvantaged, the chronically ill, and those needing 24/7 healthcare. SNP Advantage Plans are required to offer benefits & care management models to address the unique needs of these populations. The SNP’s provide a cost savings & special managed care for their members. Dual SNPs are required to provide all Original Medicare A & B benefits. Medicare Advantage SNP plans can provide benefits beyond Original Medicare; for example: Disease optimized drug formularies, OTC benefit catalogs, diabetic/disease specific supplies, vision care, routine foot care, dental, and transportation. Dual SNPs have monthly premiums at or below the Low Income Subsidy (LIS) benchmark, to cover drug costs. Dual eligible members qualifing for Low Income Subsidy, could have the federal government pay this premium on their behalf. For zero cost share duals: the state pays the Medicare Part B premium on their behalf.  The SNP Illness Plans may incorporate specific managed-care for the covered illness. A potential Dual SNP member will qualify at State’s DHS office. The Chronic Illness SNP and Nursing Home/Institutionalized member will qualify through their physician with the provider applications phone call.

*Extra-Help (LIS) is for Drug Part-D help, it is provided by Federal resources through Social Security and Medicare. It provides low cost drug coverage with the Part D for seniors with incomes above the Medicaid limits. You apply for this at you local Social Security office. Or SS.gov online see: EXTRA-HELP SS.GOV

*NOTE: PLEASE, ONLY CONSULT WITH YOUR STATE’S DEPARTMENT OF HUMAN SERVICES (DHS) & SOCIAL SECURITY OFFICES FOR INCOME QUALIFYING FOR THE DUAL SNP. FOR THE CHRONIC ILLNESS SNP TELL YOUR DOCTOR THE SNP PROVIDER WILL BE CALLING THEM. THE SENIOR FAMILY ONLY OFFERS GUIDANCE/FORMS HELP AND IS REPRESENTING THE MEDICARE PROVIDER COMPANIES WHO ARE APPROVED MEDICARE SNP PROVIDERS.

THE SENIOR FAMILY ALLIANCE IS NOT AFFILIATED  WITH THE U.S. GOVERNMENT, YOUR STATE’s DHS OFFICE, MEDICARE, OR CMS. WE ONLY WORK & ARE COMPENSATED BY THE HEALTH PLAN PROVIDER COMPANIES THAT WE REPRESENT WHEN YOU ENROLL IN A MEDICARE SNP PLAN. APPOINTMENTS SET BY STRICT MEDICARE GUIDELINES & PRE-DESIGNATED SCOPE OF THE MEETING. FORMS AND HELP WITH FORMS ARE AVAILABLE.  SENIOR FAMILY REPRESENTS 5 MEDICARE PROVIDERS OFFERING SPECIAL NEEDS PLANS. RECOMMENDATIONS ARE ONLY MADE UPON THE CLIENT'S HEALTHCARE SUITABILITY .

CONTACT: ALAN WARREN WITH THE SENIOR FAMILY ALLIANCE AT 901-217-1805.  

Al Warren

Senior Family Alliance/RX

901.217.1805 office/text