Do you have both Medicare & Medi-Cal, disabled, live in a care center, or have a chronic condition ? We may have an solution.
What in a Special Needs Plan?
A Special Needs Plan (SNP) provides benefits and services to people with specific diseases, certain health care needs, or who also have Medicaid.
SNPs include care coordination services and tailor their benefits, provider choices, and list of covered drugs (formularies) to best meet the specific needs of the groups they serve.
SNPs are either HMO or PPO plan types, and cover the same Medicare Part A and Part B benefits that all Medicare Advantage Plans cover. However, SNPs might also cover extra services for the special groups they serve. For example, if you have a severe condition, like cancer or congestive heart failure, and you need a hospital stay, an SNP may cover extra days in the hospital. You can only stay enrolled in an SNP if you continue to meet the special conditions of the plan.
Who can join an SNP?
You can join an SNP if you meet these requirements:
- You have Medicare
- You meet the eligibility requirements for one of the 3 types of SNPs:
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- Dual Eligible SNP (D-SNP)
- Chronic Condition SNP (C-SNP)
- Institutional SNP (I-SNP)
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- If you’re interested in an I-SNP, and live in a facility, check that the plan has providers that serve people where you live.
- C-SNPs can limit membership to a single chronic condition or a group of related chronic conditions.
- All SNPs use a care coordinator to help you stay healthy and develop a care plan with you.
- You can stay enrolled in a Medicare SNP only if you continue to meet the condition served by the plan. If you’re losing your plan because you no longer meet the plan’s conditions, you may be eligible for a Special Enrollment Period to join another plan.
- Your plan can’t charge more than Original Medicare for certain services like chemotherapy, dialysis, and skilled nursing facility care.
- If your plan gives you prior approval for a treatment, the approval must be valid for as long as the treatment’s medically necessary. Also, your plan can’t ask you to get additional approvals for that treatment. If you’re currently getting treatment and you switch to a new plan, you’ll have at least 90 days before the new plan can ask you to get a new prior approval for your ongoing treatment.
- Check with the plan you’re interested in for specific information.
I specialize in Special Needs Plans. SNP’s are a different type of plan. These plans usually have more services and help with lower fee’s, if you qualify .
If you would like to know about SNP’s and to see more plans available in your area, click on the green bar below. You will be redirected to our secure Medicare site or call a licensed agent,
R.Hans Anderegg CDI 0H66616 phone 619-354-0669 email hans@CalOutreach.org