I Never Knew About This Type of Medicare Plan!

As a Medicare Plan agent, when I talk about Medicare Advantage (Part C) plans to consumers, I always bring up the topic of Special Needs Plans, and people look at me like they’re lost.   Why?  Because they never heard of them at all and wished that they did because of the tailored benefits that come with it.   Frankly, not all insurance agents or carriers sell them because of additional required contracts, training, and model of care. What are Special Needs Plans?Special Needs Plans (SNP) are defined by Medicare as “…. a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.” For example, some Plans are designed for people with certain chronic health conditions like diabetes, congestive heart failure, cardiovascular disease, end stage renal disease, and COPD, while others are for people who reside in an institution or have Medicare and Medicaid.  These Special Needs Plans may include benefit structures and cost savings especially equipped for a qualifying individual and therefore could be a better fit than a regular Medicare Advantage Plan. Additionally, you could have HMO and PPO options, in some cases HMO’s may not require referrals to see Specialists. Furthermore, you may be entitled to a Special Enrollment Period to enroll in SNPs mid-year or more often in a given year.   What next?If you think you might qualify for one of these types of plans, ask your broker or agent to review those options with you so that you can decide for yourself if it stands out among the rest.To your health!