To speak with a licensed insurance agent, call (248) 450-9980 (TTY 711 M-F, 9am-5pm) or email [email protected]
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:
Autoimmune disorders
Alzheimer’s or dementia
Cancer
Cardiovascular disease, stroke, or chronic heart failure
Diabetes
End-stage renal disease, requiring dialysis
Hematologic disorders
HIV or AIDS
Chronic lung disorders (such as COPD)
Chronic or disabling mental illness
Neurologic conditions
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.
Dual-Eligible Special Needs Plans
Dual-Eligible Special Needs Plans, or DSNPs, are available to individuals who qualify for both Medicare and Medicaid. In many cases Medicaid will pay the premiums, along with a significant portion of co-pays and deductibles.
The benefits of a DSNP include the following:
Telemedicine services
Transportation to appointments and pharmacies
Dental, hearing, and vision benefits
Gym memberships
Quarterly benefits for over-the-counter products
Enrollment in any SNP is based upon geographical area, and the individual must maintain enrollment in Original Medicare. Part B premiums will still be paid to Social Security, unless Medicaid eligibility covers those. The SNP will charge a premium separately, and the patient is also responsible for co-pays and deductibles as determined by the plan.
Those who become eligible for a SNP at any point during the year are eligible for a Special Enrollment Period, during which they can select a SNP.
To speak with a licensed agent, call (248) 450-9980
(TTY 711 M-F, 9am-5pm)
Michigan License #0142917
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Medicare has neither reviewed nor endorsed this information.
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We do not offer every plan available in your area. Currently we represent ten organization which offer different plan products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.