Medicare Advantage Special Needs Plans (SNPs) are a special type of
coordinated care plan designed for people with special needs. They combine hospital care, doctor visits and other outpatient care in a single plan.
Because people who qualify for Special Needs Plans often need a considerable amount of medical care, these plans usually focus on helping members receive well-coordinated care. Some offer care managers or nurse practitioners who act as advocates to help members get the care they need when they need it.
How are these plans different from Original Medicare (Part A and Part B)?
Medicare Advantage Special Needs Plans may serve people in any of these groups:
- People who are institutionalized in a nursing home or other long-term-care facility because they are unable to care for themselves
- People who are eligible for both Original Medicare and the Medicaid assistance program
- People with certain chronic diseases, such as diabetes or heart disease
Some Special Needs Plans currently available are designed specifically to serve people who are institutionalized or people who are eligible for both Original Medicare and Medicaid (sometimes called "dual eligibles"). Some plans serve people who are both institutionalized AND eligible for Medicaid. A few plans focus on helping members deal with chronic conditions such as diabetes.
These plans are run by private companies. They use a
network of doctors and hospitals working together to provide care. Each plan creates its own network.
Choosing a Medicare Advantage Special Needs Plan
If you are interested in a Special Needs Plan, contact the plan to learn more about eligibility. Some plans may have eligibility requirements beyond just being eligible for
Original Medicare. For example, you might need to qualify for
Medicaid to join some plans. You can join a Special Needs Plan at any time during the year as long as you're eligible.
As with other Medicare Advantage (Part C) plans, details of items like premiums and cost sharing vary from plan to plan. Pay careful attention to the details of the plan before you choose.
Examples of Special Needs Plans at work
By giving you extra support with complex health needs, these plans can help you stay healthier while lowering overall costs. Here's an example of how one Special Needs Plan manages care.
- Specially trained care advocate evaluates individual's health and living conditions and defines customized plan of care.
- Primary care team is assigned to coordinate medical care and may assist members to access social services like legal aid and heating assistance.
- Telephone check-ins and visits help care advocate identify new problems early and intervene if necessary. Plan of care can be altered, or members of the primary care team can be tapped.
- Care advocate teaches people who have routine contact with the individual to be alert for signs of trouble. Family members and other caregivers can recognize valuable clues that may signal illness or change to chronic conditions.
- When an individual requires more support than is available at home, she can move to an appropriate care facility. The care advocate helps ensure there are no disruptions to the individual's care.
- When hospitalizations are necessary, the care advocate works to maintain continuity of care and helps ensure that the individual's stay is no longer than necessary.