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, there is a lot of confusion and questions surrounding them. 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:
- 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 include Medicare Part D prescription drug 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. But there are a lot of Medicare enrollees that want additional coverage, but aren’t eligible for a SNP. There are still several other options to get more health care coverage without breaking your bank.
One of the best ways to protect yourself from expensive medical costs is by purchasing a Medicare Supplemental Insurance policy. 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.
There are ten different plans on the market, all of them are named from a letter in the alphabet, spanning from A to F. Each of them covers different expenses or a portion of expenses that original Medicare doesn’t pay for. 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.
Much like the rest of Medicare, Medigap plans are regulated by the government and standardized across the Untied States. Which means that regardless of which state you live in, or who is selling the policy, the coverage is going to be identical. The only difference between the companies that sell the plans are the monthly premiums, which is why it’s important to receive quotes from several different companies before you choose one.
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.
It’s important that you get the best health care coverage that you can afford. If you have any questions about Medicare, SNPs, Medicare supplemental plans, or anything else, our agents will be happy to answer them and connect you with the best plan to fit your needs.