Medicare Advantage Special Needs Plans are varieties of Medicare Advantage Plans that are intended for Medicare beneficiaries with special; needs.

Original Medicare consists of Parts A (hospital services) and B (physician services.) It is “one size fits all” with no variations for special needs or circumstances. Medicare Advantage plans have more flexibility. They are funded differently from Original Medicare, bidding a fixed amount per patient per year to the Federal government. Funds that are not needed to provide basic Medicare services can be used to offer additional benefits, or to fund programs for special needs.

Types of Medicare Advantage Special Needs Plans

Medicare Advantage Special Needs Plans can cover extra services for chronic illnesses, special needs for institutionalized beneficiaries, or dual eligible (those entitled to both Medicare and Medicaid.) For a chronic illness Special Needs Plan, one needs to have one or more of the following conditions:

– Autoimmune disorders
– Cancer
– Cardiovascular disease, stroke, or chronic heart failure
– Alzheimer’s or Dementia
– Diabetes
– ESRD requiring dialysis
– Hematologic disorders
– HIV or AIDS
– Chronic lung disorders (like COPD)
– Chronic or disabling mental illness
– Neurologic conditions

Chronic illness special needs plans are organized county by county. It’s possible that there may not be one serving your area. If there is, the plan will offer a care coordinator who will be responsible for ensuring that you get the services you need.

Institutionalized Beneficiary Special Needs Plans

These plans are for beneficiaries who are expected to be living in an institution, and not independently, for at least 90 days. The care coordinators make sure that, between Medicare services in the community and those of the institution, your needs are met.

Dual Eligible Special Needs Plans

These plans are for those who have both Medicare and Medicaid. Generally, such beneficiaries have very limited income. The plans include some services that take that limited income into account, such as:

– Quarterly benefits for over-the-counter products
– Telemedicine services
– Transportation to and from doctor appointments or trips to the pharmacy
– Routine dental, vision, hearing services, and Gym memberships

Such plans usually pay our Medicare Advantage Plan premiums, copayments, and deductibles, and offer reduced prices on prescription drugs.

Enrolling in a Medicare Special Needs Plan

You can enroll at any time during open season (usually January 1 – March 31), or at any time if one of the following occurs:

– Moving outside of your current plan’s service area
– Qualifying for Medicaid
– Moving into, living in, or moving out of an institution
– Being diagnosed with a severe or chronic condition that qualifies you for a Chronic condition SNP

A Medicare agent can help you with enrolling in Medicare Advantage or a Medicare Advantage Special Needs Plan. If you lose your eligibility for a Special Needs Plan, say because you lose Medicaid or recover from a chronic condition, they can also assist you with enrolling in another Medicare Advantage Plan or switching back to Original Medicare.

To learn more about Medicare Advantage Special Needs Plans, reach out to Heritage First today! Heritage First offers insurance products and services. We are not affiliated with Medicare or any other government agency. Insurance products are guaranteed by the financial strength and claims-paying ability of the issuing company.