Medicare beneficiaries who suffer from chronic and debilitating illnesses such as cancer, dementia, HIV/AIDS or have suffered a stroke may be eligible for a Medicare Advantage Special Needs Plan (SNP). These SNPs may offer transportation to and from doctor appointments, hearing aids and special language interpreters for doctor appointments.
Special Needs Plans offer extra benefits
SNPs cover services and offer benefits that are not usually covered by either Original Medicare or Medicare Advantage Plans. To be eligible for a Medicare Advantage Special Needs Plan the individual must have Parts A and B of Medicare and also enrolled Medi-Cal or Medicaid. There are specific plans for both full and partial dual eligible of Medicaid- Medicare.
County and chronic illness specific
Some SNPs target specific chronic illnesses like congestive heart failure and tailor their drug formulary around medications to treat the specific illness. Because the SNPs are by county, each SNP offered may have slight differences in the benefits offered to the members.
- Chronic Condition SNP (C-SNP): You have one or more of these severe or disabling chronic conditions:
- Chronic alcohol and other drug dependence
- Autoimmune disorders
- Cancer (excluding pre-cancer conditions)
- Cardiovascular disorders
- Chronic heart failure
- Dementia
- Diabetes mellitus
- End-stage liver disease
- End-Stage Renal Disease (ESRD) requiring dialysis (any mode of dialysis)
- Severe hematologic disorders
- HIV/AIDS
- Chronic lung disorders
- Chronic and disabling mental health conditions
- Neurologic disorders
- Stroke
Some plans will include the following covered benefits
Gym Membership: for those members who can still remain active some SNPs will include a membership to a local health club.
Hearing Aids: Because hearing loss also contributes to a loss of quality of life, some plans are now offering an allowance for the purchase of hearing aids. If the hearing aid is offered, hearing exams and fittings are usually covered.
Dental Services: Some SNPs will offer a Dental HMO plans that includes routine cleanings, X-rays, fillings, crowns, root canals and the repair or replacement of dentures.
Vision and Eye wear: A modest vision benefit can also be included in SNPs. There may be coverage for exams, frames, lens within a select network of optometrists and eye wear providers.
Transportation: A serious challenge for individuals living with chronic diseases and limited incomes can be transportation to and from doctor appointments. SNPs may offer limited, one-way or unlimited transportation services. Some plans provide “door-to-door” service not only to medical appointments but dental visits as well.
Interpreter Services: Upon the request of the member, some SNP will arrange for an interpreter to be present during a doctor visit or medical procedure.
Copayments
The level of dual eligibility for both Medicaid/Medi-Cal and Medicare will determine some of the copayment amounts for certain services under the SNP. The Part D Prescription drug plan premium associated with some SNPs may also be covered by the member’s eligibility for the Low Income Subsidy. All SNPs are Health Maintenance Organizations (HMO) which helps in the coordination of care.
Visit Medicare Advantage in California for 2014 for Special Needs Plans offered in California.