Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics, and tailor their benefits, provider choices, and drug formularies (list of covered drugs) to best meet the specific needs of the groups they serve.
Who Can Join a Medicare SNP?
You can join a Medicare SNP if you have Medicare Part A and Part B, live in the plan’s service area, and meet the plan’s eligibility requirements, such as one of the following:
- You have one or more specific chronic or disabling conditions (like diabetes, congestive heart failure, a mental health condition, or HIV/AIDS).
- You live in an institution (like a nursing home), or you require nursing care at home.
- You have both Medicare and Medicaid.
Each Medicare SNP limits its membership to people in one of these groups, or a subset of one of these groups.
For example, a Medicare SNP may be designed to serve only people diagnosed with congestive heart failure. The plan would include access to a network of providers who specialize in treating congestive heart failure, and it would feature clinical case management programs designed to serve the special needs of people with this condition. The plan’s formulary would be designed to cover the drugs usually used to treat congestive heart failure. People who join this plan would get benefits specially tailored to their condition, and have all their care coordinated through the Medicare SNP.
To learn more about Medicare Special Needs Plans, you can visit the Government Medicare Website or contact Ohio Elder Law Attorneys Browning & Meyer Co., LPA today.