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Special needs plan (SNP) is a Medicare Advantage (MA) coordinated care program (CCP) specially designed to give targeted care and restrict enrollment to
special needs individuals. A special needs individual could be any of
- An institutionalized
- A dual eligible, or
- An individual with a
serious or disabling chronic condition, according to CMS.
SNP might be any type of MA CCP, including either a local or regional preferred
provider organizations (i.e., LPPO or even RPPO) plan, a health maintenance
organization (HMO) program, or an HMO Point-of-Service (HMO-POS) program. There
are three different types of SNPs:
- Chronic Condition SNP
- Dual Eligible SNP
- SNPs are expected to follow existing MA program principles, including
MA regulations at 42 CFR 422, as altered by advice, with regard to
Medicare-covered services and Prescription Drug Benefit program principles.
All SNPs must offer Part D prescription drug coverage because special
needs individuals must have access to prescription medication to manage and control
their particular medical care needs. SNPs should assume that, if no
modification is contained in guidance, existing Part C and D principles apply.
Processes for SNPs mirror the processes that CMS uses to make payments to
non-SNP MA plans. SNPs should prepare and submit bids like other MA plans,
and are compensated in the same fashion as other MA programs based on the plan’s
registration and risk adjustment payment plan. All SNPs must abide
by present CMS advice on cost sharing requirements.
Some Special Needs
Plans include care-coordination services to help you better understand your
condition and stick to your physician’s treatment regimen. Or you may have
access to wellness programs to aid with a particular diet or other lifestyle
activities that can help improve your problem. Chronic-Condition Special
Needs Plans might include supplier networks with physicians and hospitals that
specialize in treating the particular condition of its associates, or they may have formularies that are tailored to incorporate the prescription medications that treat this illness. If you are registered in a Special Needs Plan for dual eligibles, there may be certain social services available to help you coordinate your Medicare
and Medicaid benefits.
It’s important to notice
That you still get all the coverage that is otherwise comprised with Original
Medicare, Part A and Part B, and Medicare Part D. The Special Needs Plan simply
offers extra coverage to help you better manage your particular situation,
whether that’s residing in a nursing home; coordinating your Medicare and
Medicaid benefits; or treating a serious chronic illness.
1 key difference
Between a Special Needs Plan and other types of Medicare Advantage programs is
that all Special Needs Plans should cover prescription medications. In contrast, other
Medicare Advantage plans (for example, HMOs and PPOs) may or may not contain prescription drug coverage, depending on the particular plan.
Special Needs Plans costs
Based on the
Special Needs Plan, you will generally have the following costs:
Monthly premium to your
Special Needs Plan
Prescription drug coverage (if your SNP requires it)
Extra monthly premium for
Additional advantages (if your SNP requires it)
Cost-sharing expenses, such as
copayments, coinsurance, or deductible