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Medicare Advantage Special Needs Plans

Cheerful senior woman sitting on sofa and holding walking stick on a Medicare Advantage Special Needs Plan.

There are several types of Medicare Advantage Plans. Private insurance companies offer SNPs (Special Needs Plans). These plans are only for individuals with specific, unique needs. Individuals enrolling in an SNP plan must meet requirements after being enrolled in Parts A and B.

Types of Medicare Advantage Special Needs Plans

There are three types of Special Needs Plans.

Chronic-Condition SNP

As the term implies, these plans are for individuals with disabling chronic conditions. These are cancer, dementia, AIDS/HIV, some autoimmune diseases, and cardiovascular disorders.

Dual-Eligible SNP

This SNP plan is for beneficiaries who are enrolled in both Medicare and Medicaid.

Institutional SNP

Medicare beneficiaries living in an institution – like a nursing home – are eligible for this plan.

You will need to speak with a knowledgeable agent at Senior Benefits Solutions to determine if you qualify for one of these plans.

Nurse assisting senior woman at nursing home with a Medicare Advantage Special Needs Plan.
Medicare beneficiaries living in an institution – like a nursing home – are eligible for this plan.

Medicare Advantage Benefits

Because Medicare Advantage plans bundle benefits from Medicare Parts A and B, they must offer the same benefits provided by Parts A and B. This coverage applies to inpatient and outpatient care, skilled nursing facility care, diagnostic tests, surgeries, home health care, durable medical equipment (DME), and preventive services.

Medicare Advantage plans include additional benefits not seen in Original Medicare. Some of these services are:

  • dental care
  • hearing exams
  • hearing aids
  • vision exams
  • glasses or contact lenses
  • gym memberships
  • wellness and nutrition programs
  • over-the-counter drugs
  • prescription drugs
  • adult daycare
  • transportation to doctor visits
  • services for chronic conditions
  • SNP plans are required to provide prescription drug coverage. The drug formulary will be tailored to the condition you present with.

Care coordination benefits are often a part of SNP plans. This coordination will be specific to the chronic condition being treated. This can help by providing wellness plans tailored to help you coordinate your diet and activities that may help improve your situation.

You may also have better access to providers and facilities that specialize in treating your condition.

When you can enroll

Once you are enrolled in both Medicare Parts A and B, you can also enroll in a Medicare Advantage plan. There are specific enrollment periods that apply to Medicare Advantage plans.

Initial Election Period

Each individual has their Initial Election Period. This period begins three months prior to your 65th birthday and extends three months after your 65th birthday, for a total period of seven months.

If you are receiving disability benefits from Social Security, you are eligible for Medicare after receiving disability benefits for 24 months. You may apply for an MA plan three months prior to your eligibility date (which would begin on the 25th month of your disability benefits). This enrollment period extends to three months after your eligibility date.

Special Election Period

To qualify for a Special Election Period, you must meet specific requirements. The most common way individuals qualify is if they postpone enrollment into Original Medicare because they have other creditable insurance coverage. Once the individual enrolls in Original Medicare, they are also eligible to enroll in Medicare Advantage.

Other qualifying events include moving outside your plan’s coverage area, your plan getting terminated for reasons outside of your control, or you qualify for Extra Help.

To find out if you qualify for a Special Election Period, give Senior Benefit Solutions a call!

Annual Election Period

The Annual Election Period (AEP) occurs each fall from October 15 through December 7. During this time, you can choose to change or drop your current Part C plan. Your new coverage will begin on January 1.

Medicare Advantage Open Enrollment Period

This is often confused with AEP. However, there are other things you can do during the Open Enrollment Period, which runs from January 1 through March 31 each year.

During Open Enrollment, you may disenroll in your current MA plan and switch back to Original Medicare. The opposite is also true – you may change from Original Medicare to Medicare Advantage.

You may also switch MA plans, disenroll from your Part D prescription drug plan, and switch from your current Part D plan to another Part D plan.

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