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What is a Medicare Special Needs Plan?

Written by Jason Patterson

Although Medicare covers a wide range of health care services for its enrollees, there are some individuals who are eligible for a special type of Medicare plan. This plan is known as a Medicare Special Needs Plan, or an SNP. Because these plans aren’t as common, the confusion is widespread about what it offers. For anyone that is eligible, it’s important to understand the advantages of the SNPs.

An SNP is a private Medicare Advantage plan that requires certain eligibility requirements, based primarily on various health conditions or living situations, for its membership. These types of plans serve specific individuals or groups, such as:Medicare Advantage Special Needs Plans

  • Residents of skilled nursing home facilities
  • Recipients of home health care
  • Dual eligibles (individuals who are eligible for both Medicare and Medicaid benefits)
  • Individuals who have been diagnosed with certain conditions such as diabetes or end stage renal disease (ESRD)
  • Those who reside in certain states

While Medicare Advantage plans must include the same benefits that are offered by Medicare Part A and Part B, Medicare Special Needs Plans typically also offer different types of benefits than Original Medicare (Medicare Parts A and B), as the benefits in a plan tend to be more focused and more specialized in the care that is offered. This is because the benefit recipients usually have very specific care related needs.

How Do SNPs Operate?

Similar to with regular Medicare Advantage plans, Special Needs Plans are also set up to operate as either an HMO (Health Maintenance Organization) or a PPO (Preferred Provider Organization). Here, participants will need to use the services of the health care providers that are located in the plan’s network. In a PPO situation, enrollees may use an out-of-network provider, however, this will typically require a higher amount of copayment.

Some exceptions to the in-network rule include receiving emergency care due to a sudden injury or illness that requires immediate attention, as well as care for those who have end stage renal disease and require out-of-area dialysis.

Likewise, the plan participants will usually also be required to get a referral from their primary care physician before they are allowed to see a specialist. There are, however, certain types of services that will not require a referral. Preventive care such as mammograms are one such example. Many Medicare SNPs may also offer Part D coverage.

Enrolling in a Medicare Special Needs Plan

Individuals can enroll in a Medicare Special Needs Plan when they initially become eligible for Medicare. This means that they can actually go through the enrollment procedure at any time beginning three months prior to the month that they turn age 65, as well as during the month of their 65th birthday, and any time three months after the month in which they turn 65.

In addition, there are some exceptions to the time frame for enrollment in a Medicare Special Needs Plan as well. For example, if a person is already receiving Medicare because they are disabled, they can enroll in an SNP starting three months prior to through three months after the 25th month in which they first became disabled.

The SNP is a great way to get additional coverage that Original Medicare may not provide. The cost of health care can quickly drain a bank account and cause financial strain on a family. So what do you do if you want extra coverage but aren’t SNP eligible? There are still several other options to get more health care coverage without breaking your bank.

Our first suggestion is to do research on Medicare Supplement plans. Also known as a “Medigap plan,” they are sold through private insurance companies and help will in all of the unpaid expenses left behind by Original Medicare. Some of these expenses include excesses charges, copayments, premiums, and more.

Each of the 10 plans available for purchase are named from a letter in the alphabet, spanning from A to F. They differentiate themselves by the level of coverage they provide. Medicare Plan A is the most basic supplemental insurance plan offered, it covers the least amount of gaps, while Medicare Plan F covers the most. Because of how inclusive it is, Plan F is one of the most popular plans sold.

Unlike a SNP, Medigap plans are sold in every state. While you might not be able to purchase all ten of the plans, you will be able to choose from a couple of them. The only requirements to enroll into one of these plans is that you have to be 65 and be enrolled in Medicare Parts A and B. These plans are much easier to qualify for compared to the SNPs.

These Medigap plans fall in line with government regulations. So no matter what state you reside the each plan has to cover the same thing. You may ask why then do i need to get prices before purchasing? Because all companies offer different rates. We highly recommend getting quotes from several different companies.

Instead of having to call several different companies to receive quotes, we can bring all of the lowest quotes to you. Fill out the quote form and we will give you the lowest rates available. You’re time is valuable, don’t waste it talking to dozens of insurance agents.

Affordability is the main goal when looking to buy extra insurance protection. Let us help answer any questions you have about SNP plans. We can also go over any concerns you have about being eligible for SNP, or other Medicare plans.

About us
About us

Jason Patterson has been in the insurance industry for over fifteen years. Starting in 2005, he became one of the first agents to sell medicare supplements online. From that small start, he grew an agency that helped thousands of people with their insurance needs in all fifty states.

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