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Health Insurance Basics

Manage Your Chronic Condition With a Medicare Advantage Special Needs Plan

September 07, 2017

Many people live with chronic conditions that require specialized services or treatments. If you have a qualifying condition, you could get health coverage specifically designed to help you manage it with a Medicare Advantage Special Needs Plan. It may cover almost everything you need to take care of your health.

Here’s a Quick Overview of Medicare Advantage Special Needs Plans

Medicare Special Needs Plans (SNPs), also known as Medicare Advantage SNPs, are a type of  Medicare Advantage plan structured to meet the unique health care needs of people with particular diseases or circumstances. They are run by private companies that are approved by Medicare and often work like a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO).

Because they’re limited to qualifying individuals, these Medicare Advantage SNPs can concentrate on covering all the health care services considered medically necessary for their members by offering:

  • Specific health care provider choices, including doctors who specialize in a particular illness.
  • A focused drug list of covered prescriptions (formulary) that treat their members’ specific diseases.

Every Medicare SNP must include Medicare prescription coverage (Medicare Part D). Many also provide professional care coordination services, with personal guidance and programs that help you follow your doctor’s orders and maintain your health.

As with many  Medicare plans, if you enroll in a Medicare SNP you may have to visit doctors, hospitals and other facilities that are in your plan to receive covered services. And you might need to choose a primary care doctor and/or get referrals to see any specialists. The Medicare SNP should include all types of specialists needed to treat its members’ particular disease or condition.

It’s Easy to Find Out If You Qualify for a Special Needs Plan

There are three different types of SNPs:

  1. Chronic Condition SNP (C-SNP)
  2. Dual Eligible SNP (D-SNP)
  3. Institutional SNP (I-SNP)

You may choose to join a SNP if you have Medicare Parts A and B, live in the plan’s service area, and meet the plan’s eligibility requirements. Let’s look at each type of SNP in detail.

Chronic Condition SNP (C-SNP)

You may qualify if you have one or more of the following severe or disabling chronic conditions:

  • Chronic alcohol and other drug dependence
  • Autoimmune disorders
  • Cancer (excluding pre-cancer conditions)
  • Cardiovascular disorders
  • Chronic heart failure
  • Dementia
  • Diabetes mellitus
  • End-stage liver disease
  • End-Stage Renal Disease (ESRD) requiring any mode of dialysis
  • Severe hematologic disorders
  • HIV/AIDS
  • Chronic lung disorders
  • Chronic and disabling mental health conditions
  • Neurologic disorders
  • Stroke

A Chronic Condition SNP may focus on one chronic condition or several combined.

Institutional SNP (I-SNP):

You may qualify if you live in an institution like a nursing home or you need nursing care at home.

Dual Eligible SNP (D-SNP):

You may qualify if you’re eligible for both Medicare and Medicaid.

You’ll find many private insurance companies in your area offer a Medicare Advantage Special Needs Plan for Dual Eligibles. You can check with the SNP directly to confirm that you qualify — and enroll in a plan that will help you manage your specific disease or circumstance with the right health care.

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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. HMO plans are administered by Anthem Health Plans of New Hampshire, Inc. and underwritten by Matthew Thornton Health Plan, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. Anthem Blue Cross and Blue Shield and its affiliate HealthKeepers, Inc. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWi), underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare Health Services Insurance Corporation (Compcare) or Wisconsin Collaborative Insurance Corporation (WCIC). Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are the registered marks of the Blue Cross and Blue Shield Association.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium.

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