Special Needs Plans
A Medicare Special Needs Plan is a type of Medicare Advantage plan. Also called SNPs.
SNPs are limited to membership from people with specific diseases or characteristics. The plans are designed to meet the needs of the specific groups they serve. All SNPs have prescription drug coverage included with the plan. There are 4 kinds of SNPs.
- Dual Special Needs Plans (D-SNPs) for people who have both Medicare and Medicaid (called “dual eligible”)
- Chronic Special Needs Plans (C-SNPs) for people living with severe or disabling chronic conditions
- Institutional Special Needs Plans (I-SNPs) for people who live in a skilled nursing facility
- Institutional-Equivalent Special Needs Plans (IE-SNPs) for people who live in a contracted assisted living facility and need the same kind of care as those who live in a skilled nursing facility
A D-SNP doesn’t replace your Medi-Cal plan or change your Medi-Cal eligibility. You’ll keep the same Medi-Cal plan you have today, and you’ll still get all the same Medi-Cal benefits you get now.
In addition, you will also receive additional benefits such as:
● Dental, vision and hearing coverage
● Care coordination via a personal care coordinator
● Personal emergency response system (PERS)
● 24/7 Tele-health options
● Credits to buy over the counter health products
● Transportation assistance
● In-home health care
● Fitness membership
● Utility bill credits
● Plus much more
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Chronic Special Needs Plans (C-SNPs) are for people with a severe or disabling long-term health problem.
There are 15 SNP-specific chronic conditions approved by the Centers for Medicare & Medicaid Services (CMS):
● Chronic alcohol and other drug dependencies
● Autoimmune disorders limited to: Polyarteritis nodosa, Polymyalgia rheumatica, Polymyositis, Rheumatoid arthritis and Systemic lupus erythematosus
● Cancer (excluding pre-cancer conditions or in-situ status)
● Cardiovascular disorders limited to: Cardiac arrhythmias, Coronary artery disease, peripheral vascular disease and Chronic venous thromboembolic disorder
● Chronic heart failure
● Diabetes mellitus
● End-stage liver disease
● End-stage renal disease (ESRD) requiring dialysis
● Severe hematologic disorders limited to: Aplastic anemia, Hemophilia, Immune thrombocytopenic purpura, Myelodysplastic syndrome and Sickle-cell disease (excluding sickle-cell trait)
● Chronic lung disorders limited to: Asthma, Chronic bronchitis, Emphysema, Pulmonary fibrosis and Pulmonary hypertension
● Chronic and disabling mental health conditions limited to: Bipolar disorders, Major depressive disorders, Paranoid disorder, Schizophrenia and Schizoaffective disorder
● Neurological disorders limited to: Amyotrophic lateral sclerosis (ALS), Epilepsy, Extensive paralysis (hemiplegia, quadriplegia, paraplegia, monoplegia), Huntington’s disease, Multiple sclerosis, Parkinson’s disease, Polyneuropathy, Spinal stenosis and Stroke-related neurologic deficit
Institutional Special Needs Plans (I-SNPs) are for individuals who live in a care facility like a nursing home or get nursing care at home. These plans are for people who have had, or are expected to need, for 90 days or longer, the level of services provided in one of the following:
● A long-term care skilled nursing facility
● A long-term care nursing facility
● A skilled nursing facility/nursing facility
● An intermediate care facility for individuals with intellectual disabilities
● An inpatient psychiatric facility
Institutional-Equivalent Special Needs Plans (IE-SNPs) are for people who live in an assisted living facility and get the same kind of care as in a skilled nursing facility.
Eligibility and Enrollment
As far as eligibility goes to enroll in a SNP you should check with your insurance professional to see if you would qualify for a plan in your county.
If you have Medicare and Medicaid/Medi-Cal, you may have heard the term Medi-Medi.
This means most of the costs associated with healthcare will be at near $0 to you.
Medi Medi plans usually offer the greatest benefits at the least cost, if there is a cost at all.
If you do qualify as a a Medi-Medi, you just have to make sure you stay enrolled in Medicaid/Medi-Cal to maintain your eligibility.