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Medicare Special Needs Plans for Recipients

Like the name says, a Medicare Special Needs Plans is a unique type of Advantage Plan (Part C) designed to provide specialized care for patients suffering from specifically listed terminal or chronic illness, including chronic alcohol and drug dependence. Although it is possible that other illnesses will be considered under a particular plan, these special needs conditions typically include autoimmune disorders, cancer (does not include pre-cancer conditions, chronic heart failure, cardiovascular disorders, dementia, diabetes mellitus, end-stage liver and renal disease, severe hematologic disorders, HIV/AIDS, chronic lung disorders, chronic disabling mental conditions, neurological disorders, and stroke. Because all of the services are provided under the umbrella of one plan, coordination of all of your health care needs is much more simplified.

Medicare SNPs are required to use Medicare coverage rules to decide which services are considered medically necessary. The plans must cover all medically necessary and preventive services covered under Medicare Part A and Part B and prescription drug coverage under Part D. They may also cover extra services that are specific to the special groups they serve. It is important that you find out exactly what is covered before you join a plan.

The plans are designed to help manage and coordinate all services for patients falling into one or more of the categories listed above. This includes prescription drug coverage, medical health care, and hospital care. For example, a patient with a chronic lung disorder would have access to a network of providers whose concentration is treating only lung disorders. Just like any other Medicare health plan, you will have to choose providers and hospitals that belong to the plan and get referrals to see other specialists. If you are out of a service area and have an emergency, those costs are covered.

Like Medicare Advantage Plans, Medicare SNPs are run by private companies. The costs of the plan will depend on the type of health care services you need, how often you receive them, and what your plan charges for any benefits that are considered extra. Typically, you pay your Medicare Part B premium; any additional monthly premium the Medicare SNP charges (above the Medicare Part B premium for Part A and Part B services); any additional monthly premium the Medicare SNP charges for prescription drug benefits; any plan deductible, coinsurance, or copayment the Medicare SNP charges (typically falling in the range of $10-$20 per doctor visit); and any additional charges associated with extra benefits. In order to find out more information about these extra costs, you will need to contact the Medicare SNP.

If you are on a limited income, you can apply for Extra Help to assist you in paying for prescription drugs. If you qualify, you may be able to get your prescriptions filled at little to no cost to you. To apply for this coverage, you can contact the Social Security Office at 800-772-1213 (TTY users should call 1-800-325-0778); visit your local Social Security Office; or visit www.socialsecurity.gov/i1020.

If you are interested in joining a Medicare SNP, please visit www.medicare.gov/find-a-plan or call1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.


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