Manage Your Chronic Condition With a Medicare Advantage Special Needs Plan

Many people live with chronic conditions that require specialized services or treatments. If you have a qualifying condition, you could get health coverage specifically designed to help you manage it with a Medicare Advantage Special Needs Plan. It may cover almost everything you need to take care of your health.

Here’s a Quick Overview of Medicare Advantage Special Needs Plans

Medicare Special Needs Plans (SNPs), also known as Medicare Advantage SNPs, are a type of  Medicare Advantage plan structured to meet the unique health care needs of people with particular diseases or circumstances. They are run by private companies that are approved by Medicare and often work like a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO).

Because they’re limited to qualifying individuals, these Medicare Advantage SNPs can concentrate on covering all the health care services considered medically necessary for their members by offering:

• Specific health care provider choices, including doctors who specialize in a particular illness.
• A focused drug list of covered prescriptions (formulary) that treat their members’ specific diseases.

Every Medicare SNP must include Medicare prescription coverage (Medicare Part D). Many also provide professional care coordination services, with personal guidance and programs that help you follow your doctor’s orders and maintain your health.

As with many  Medicare plans, if you enroll in a Medicare SNP you may have to visit doctors, hospitals and other facilities that are in your plan to receive covered services. And you might need to choose a primary care doctor and/or get referrals to see any specialists. The Medicare SNP should include all types of specialists needed to treat its members’ particular disease or condition.

It’s Easy to Find Out If You Qualify for a Special Needs Plan

There are three different types of SNPs:

1. Chronic Condition SNP (C-SNP)
2. Dual Eligible SNP (D-SNP)
3. Institutional SNP (I-SNP)

You may choose to join a SNP if you have Medicare Parts A and B, live in the plan’s service area, and meet the plan’s eligibility requirements. Let’s look at each type of SNP in detail.

Chronic Condition SNP (C-SNP).

You may qualify if you have one or more of the following severe or disabling chronic conditions:

• Chronic alcohol and other drug dependence
• Autoimmune disorders
• Cancer (excluding pre-cancer conditions)
• Cardiovascular disorders
• Chronic heart failure
• Dementia
• Diabetes mellitus
• End-stage liver disease
• End-Stage Renal Disease (ESRD) requiring any mode of dialysis
• Severe hematologic disorders
• HIV/AIDS
• Chronic lung disorders
• Chronic and disabling mental health conditions
• Neurologic disorders
• Stroke

A Chronic Condition SNP may focus on one chronic condition or several combined.

Institutional SNP (I-SNP):

You may qualify if you live in an institution like a nursing home or you need nursing care at home.

Dual Eligible SNP (D-SNP):

You may qualify if you’re eligible for both Medicare and Medicaid.

You’ll find many private insurance companies in your area offer a Medicare Advantage Special Needs Plan for Dual Eligibles. You can check with the SNP directly to confirm that you qualify — and enroll in a plan that will help you manage your specific disease or circumstance with the right health care.

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A CONSUMER’S GUIDE TO HEALTH INSURANCE FOR PEOPLE ELIGIBLE FOR MEDICARE MAY BE OBTAINED FROM YOUR LOCAL SOCIAL SECURITY OFFICE OR FROM THIS INSURER

Empire BlueCross BlueShield is an HMO plan with a Medicare contract. Enrollment in Empire BlueCross BlueShield depends on contract renewal. Services provided by Empire HealthChoice HMO, Inc. licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.

Services provided by Empire HealthChoice Assurance, Inc., licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium.

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