Knowing Your Medicare Advantage Options

Medicare Special Needs Plans (or SNPs) are designed to meet the needs of people suffering from specific conditions or diseases.

Medicare Advantage Plans are optional Medicare plans offered by Medicare-approved private companies and available to people already enrolled in Medicare Part A and Medicare Part B.

Special Needs Plans require you to receive services from health care providers belonging to your particular SNP. You will normally need a referral before seeing a specialist, and as an SNP policyholder you will receive all your Medicare hospital, medical health care services, and prescription drug coverage through your SNP.

SNP membership is limited to those living in a plan’s service area and having one or more chronic qualifying conditions, including alcohol or drug dependency, cancer, dementia, heart failure, and cardiovascular and lung disorders. You can find a complete list of qualifying conditions from Medicare.gov by clicking here.

Enrolling in an SNP

Joining a Medicare Special Needs Plan does not affect your eligibility for all medically-necessary services covered by Medicare Part A and Part B.

Medicare Part A pays primarily for inpatient hospital services, skilled nursing facility care after a hospital stay, home health care, and hospice care. Plan B, meanwhile, helps pay for medical expenses, clinical laboratory services, and outpatient hospital treatment. Coverage in these areas is not affected by enrollment in a Medicare Special Needs Plan. You should be aware, however, that an SNP may not cover the cost of a procedure not deemed medically-necessary under Medicare, and this can result in high out-of-pocket costs for services your insurer deems unnecessary.

You can request an advance coverage decision from your insurer, and you have the right to appeal your insurer’s decision concerning what medical services are or aren’t necessary. But it’s important to choose a plan and insurer you can trust.

Availability of SNPs varies in different parts of the country, and even within individual regions and states. Premiums, deductibles, coinsurance, and copayment amounts can vary widely as well, although people with both Medicare and Medicaid generally find their expenses to be very affordable.

With so many options and details to consider, you need an expert like MedicareMall in your corner to ensure you’re getting the best coverage available at the lowest possible cost. We’re eager to answer any questions you may have about Medicare Special Needs Plans. Contact MedicareMall now and let us put our two decades-plus of experience to work for you!

Resources: Your Guide to Medicare Special Needs Plans (SNPs) [PDF]

Medicare Advantage Plans
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