A blog about Medicare. What you and your employees need to know
Special- Medicare Targeting Conditions
Author: Lora Drummond
Medicare Transition Specialist
44- 52 Solution Series – Special – Medicare Targeting Conditions
This month we are enjoying our furbaby grandson Charlie, who is visiting with us from the Midwest. He’s a sweet Chocolate Labrador that we rescued from a rescue group more than six years ago. He went with my daughter last year when she moved out of state for a new job. So we are delighted to have him bouncing around the house again for a few weeks.
Last January, he gave my daughter quite a scare when he developed a serious medical condition that was surprisingly diagnosed as Diabetes. Now that he is staying with us, I never realized all the care involved in managing the disease. From diet to insulin scheduling and monitoring, it can be rather challenging. Thankfully, many of the same methods humans follow in managing the disease work well for dogs too. But it doesn’t cure it, and the costs have been eye-opening without medical insurance.
Plans for Chronic Conditions
Since this month is National Diabetes Month, and I am learning firsthand about caring for a furbaby with the condition, I thought it was the perfect time to discuss Medicare special needs plans. Did you know there are Medicare plans designed to target some folks with chronic medical conditions? Diabetes is one of them. I sure wish Charlie was eligible for Medicare!
So what are these plans? Special Needs Plans (SNP) are Medicare Advantage plans that provide additional targeted coverage to folks who need more help. There are 3 different categories of SNPs, but for this article, I am focusing only on C-SNPs tailored for managing specific chronic medical conditions. The Medicare.gov site lists quite a few medical conditions where there might be a SNP plan available to benefit folks with Diabetes, end-stage liver disease, chronic lung disorders, and autoimmune disorders, to name a few.
Benefits of SNPs
To enroll in a C-SNP plan, a person must meet the plan’s eligibility conditions, supply a medical letter from their doctor confirming their condition and, of course, already be enrolled in Parts A and B of Medicare. However, C-SNP plans are not available in every state and, like most Medicare plans, need to be reviewed every year for area availability, and cost changes. But for areas in which these plans are available, they are worth looking into.
Medicare C-SNPs are managed by insurance companies, just like other Medicare Advantage plans. So all the usual Medicare benefits of hospitalization, medical services, and prescription drug coverage (included with most plans) are incorporated along with some additional features which help manage a person’s specific condition.
In addition to the medical conditions they are targeted to treat, there would be a network of providers and a formulary of medications and, in some cases, a care coordinator to help them stay healthy and follow their doctor’s orders. Medicare C-SNPs may also cover extra days in the hospital or helpful social services. Again, because managing a chronic condition differs from other medical conditions, these plans provide targeted comprehensive care.
Evaluating a Plan Change
If you know someone with a chronic medical condition, Medicare’s Annual Election Period (AEP) (Oct 15- Dec 7) would be an excellent time to evaluate the benefit of switching plans. Just like when choosing other Medicare Advantage plans, it’s important to shop for a C-SNP that targets a person’s medical condition and meets budget needs. Certified Medicare Planners® can help folks decide if a C-SNP plan would benefit them and show them how to enroll.
( Note: If someone qualifies for a SNP, they can enroll during any month of the year, as a newly diagnosed or worsening condition would qualify them for a special enrollment period. Folks are not just restricted to the AEP to enroll.)
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