If you are unsatisfied with the benefits offered by the standard Medicare program, Original Medicare, you can choose to have your Part A, B, and D served to you by a third party insurance provider. These policies are offered as Part C of Medicare, Medicare Advantage.
Advantage plans come in several different forms, one of which is the Special Needs Plan. A Special Needs Plan is structured to benefit a specific group of people, oftentimes a group of people who have been diagnosed with one of several chronic conditions. This is what you need to know before seeking a Medicare Advantage Special Needs plan.
What Is Medicare Advantage?
Medicare Advantage is a government program designed to offer senior citizens and people with disabilities access to affordable health care coverage. Advantage plans are administered by third-party providers who have contracted with Medicare to provide people with their Medicare benefits. There are many types of Medicare Advantage plans, each offering unique benefits and drawbacks.
What Is A Special Needs Plan?
A Special Needs Plan is a Medicare Advantage coordinated care plan that is designed to provide targeted care to special needs individuals. The term “special needs” applies to people in three different categories, they include:
- Institutionalized individuals
- Dual eligible individuals
- Individuals with sewerage and disabling chronic conditions
In turn, there are three different types of Special Needs Plans, including:
- Chronic Condition SNP (C-SNP)
- Dual Eligible SNP (D-SNP)
- Institutional SNP (I-SNP)
How Do Special Needs Plans Work?
If you are a member of a Special Needs Plan, you will likely be required to receive health care services from doctors and hospitals that are within your plan’s network. The exceptions to this rule apply when you are receiving emergency or urgent care as well as if you have End-Stage Renal Disease and need out-of-area dialysis. As long as you receive care within your plan’s network, your Special Needs Plan will help pay for covered health care costs.
Do Special Needs Plans Cover Prescription Drugs?
A majority of Medicare Advantage plans prescription drug coverage, and Special Needs Plans follow this trend. The drugs covered under your specific policy may vary based on the formulary offered by the insurance provider, so check with your preferred provider to ensure that your medications are covered under a policy before applying. In some cases, insurance companies may make exceptions and pay for you to access a specific drug.
Find A Special Needs Plan
The Medicare specialists at The Fussell Group Insurance Advisors can help you find a Medicare Advantage Special Needs Plan that suits your specific needs. Reach out to us now to get started with a consultation.