May 19, 2011
Medical Special Needs Plan
What is a Medicare Special Needs Plan?
A Medicare Advantage Special Needs Plan, otherwise known as a SNP, is a Medicare Advantage plan that is exclusively designed for the unique needs associated with one of the following categories:
- A particular type of chronic or disabling health condition covered by SNPs (e.g. diabetes)
- Simultaneous enrollment in Medicaid and Medicare
- Residence in certain institutions such as a nursing home
Since a SNP is a Medicare Advantage plan, both Part A and Part B benefits are provided by the plans as well as prescription drug coverage. Along with the plan's general health benefits, SNPs tailor their benefits, healthcare providers, and drug coverage to meet the specific needs associated with the chronic condition addressed by the plan.
Eligibility for Medicare SNP
In order to enroll in a SNP, you must meet the following qualifications:
- Enrollment in Medicare Part A and Part B
- Reside in the plan's coverage region
- Satisfy the SNP's enrollment criteria (e.g. a specific medical condition associated with the SNP or residence in an institution or reception of health care in a home setting or enrollment in both Medicare and Medicaid)
SNPs can help plan members follow doctor's instructions related to diet and prescription drug use. SNPs targeting people simultaneously enrolled in Medicare and Medicaid may assist with the coordination of Medicare and Medicaid services.
People enrolled in SNPs pay their Medicare Part B premium as well as the SNP's monthly premium.
There are SNP plans available for the below chronic or disabling conditions. However, these SNPs are not available in every region.
Diabetes
Diabetes, a medical condition related to the body's regulation of blood sugar, is one of the conditions for which there are SNPs. According to statistics from the American Diabetes Association, over 26.90% of seniors age 65 and older have diabetes.
Congestive Heart Failure
Congestive heart failure is when the heart's blood output is low and leads to a build-up of fluid within the body. Congestive heart failure is an approved condition for which SNPs are offered.
End Stage Renal Disease
End Stage Renal Disease, ESRD, is kidney-related health problem that qualifies U.S. citizens for Medicare benefits even if the person suffering from ESRD is under the age of 65.
HIV/AIDS
HIV/AIDS is a health problem of the immune system and is included among the chronic conditions for which SNPs are offered. HIV/AIDS SNPs coordinate care related to this condition and may help a beneficiary understand side-effects of HIV/AIDS medications or how to discuss HIV/AIDS with loved ones.
Osteoarthritis
There are SNP plans serving Medicare beneficiaries suffering from the most common form of arthritis: osteoarthritis. Osteoarthritis is a degenerative joint disease that causes the cartilage in a joint to become stiff, thus leaving it more vulnerable to damage.
Mental Health Conditions
There are a variety of mental health conditions covered by Medicare SNPs. They include but are not limited to:
- Anxiety disorders
- Depression
- Schizophrenia
The SNP coordinates among psychiatrists, psychologists, physicians, nurses, social workers, and other healthcare providers involved in the treatment of the member's mental health condition
