Special medical situations require specialized care. Medicare Special Needs Plans (or SNPs) were created with this principle in mind.
SNPs are Advantage Plans that are tailored to meet the needs of individuals with certain health conditions or circumstances.
The plan network, benefits, and drug formulary are all centered on the patient’s condition in order to provide the appropriate support. Many SNP plans also assign care coordinators to assist patients in managing their condition, following physician orders, accessing community resources, and obtaining timely prescriptions.
To qualify for a Special Needs Plan on the basis of chronic illness, the Medicare beneficiary must be diagnosed with one or more of the following conditions:
Cardiovascular disease, stroke, or chronic heart failure
End-stage renal disease, requiring dialysis
Chronic lung disorders (such as COPD)
Chronic illness SNPs vary by geographical area, with insurance companies deciding where certain plan designs are offered. Therefore, not all patients with chronic conditions will be able to locate a plan designed around their needs in their area. Additionally, moving to a new home in a different coverage area will impact eligibility. A licensed insurance professional can offer more assistance in locating these plans.
Some other types of Special Needs Plans include Institutional SNPs and Dual-Eligible SNPs. A patient who is expected to be institutionalized for 90 days or longer might be eligible for an Institutional SNP, designed to coordinate the care of a patient no longer living independently.
