Caregiver Corner: Is a Special Needs Plan Right for Your Loved One?Posted by Medicare Made Clear
Caregiver Corner is designed for those who are helping their loved ones make informed health care decisions. Whether you’re a coach, main care provider or decision maker, Caregiver Corner helps you help your loved one.
As a caregiver, one of your jobs might be to help a loved one choose the right Medicare plan. When looking at your options, you might have come across Special Needs Plans. But how do you know if a Special Needs Plan might be right for your loved one?
What is a Special Needs Plan?
A Special Needs Plan (SNP) is a type of Medicare Advantage plan. It’s designed for people with specific illnesses or other special health care needs. SNPs offer the same benefits as Original Medicare: hospital and medical insurance. And all SNP plans must include prescription drug coverage. They also offer coordinated care for chronic medical conditions, like congestive heart failure (CHF) or diabetes. The goal of most SNPs is to help people stay healthier while lowering their overall healthcare costs.
Speaking of costs, it might be a good idea to compare a few plans to make sure your loved one is getting the best value for their money. Costs and cost sharing—like deductibles, copays or coinsurance—are set by a specific plan. And costs can vary from plan to plan. Total costs will generally depend on the services and prescription drugs used.
To be eligible for an SNP, your loved one first needs to qualify for Original Medicare. After that, there are three main groups of people who may qualify for a SNP.
1. People who live in a nursing home or assisted living facility because they can’t care for themselves. For people who live in long-term care facilities, SNPs offer specialized attention. This may include visits from nurse practitioners and care coordinated with doctors and family members.
2. Dual Eligibles: People who qualify for both Medicare and Medicaid. Medicaid is a government service that can help eligible persons pay Medicare premiums and cost sharing. If your loved one qualifies for Medicaid, there are Special Needs Plans designed especially for their unique needs and situation. There are also SNPs for people who are residents of long-term care facilities (see #1 above) AND who are “dual eligibles.”
3. People with certain chronic medical conditions, like heart disease or diabetes. There are Special Needs Plans tailored to specific chronic health conditions. These offer coordinated care management. This means there are dedicated specialists and nurse practitioners who create and actively manage the care plan that best meets your loved one’s health care needs. This will hopefully help keep your loved one out of the hospital as much as possible and help them be as healthy as possible.
When can they enroll?
If your loved one qualifies for an SNP because of a chronic or disabling illness, they can join at any time during the year. This means they don’t have to wait for the Medicare Open Enrollment Period (OEP) or another enrollment window. After joining a plan, your loved one’s enrollment window will close until the next year’s OEP.
A Special Plan for Those with Diabetes
November is National Diabetes Month. Are you a caregiver to a person with diabetes? If so, this might be a good time to look into an SNP designed with your loved one’s needs in mind. Some of the benefits an SNP for people with diabetes may offer your loved one include:
- Built-in prescription drug coverage
- A care manager to create a plan for coordinating your loved one’s care
- Help finding out if your loved one qualifies for help paying Medicare costs
- Discounted prices on the prescription drugs your loved one takes
- Help finding ways to live healthier
As a caregiver, it may be worth it to find out whether or not your loved one qualifies for a Special Needs Plan. The coordinated care of SNPs gives you a whole team of health care professionals to back you up in the important work you do.
For more information, contact the Medicare helpline 24 hours a day, seven days a week at 1-800-MEDICARE (1-800-633-4227), TTY 1-877-486-2048. If you have questions about Medicare Made Clear, call 1-877-619-5582, TTY 711, 8 a.m. – 8 p.m. local time, seven days a week.
The family of UnitedHealthcare® Medicare Solutions plans are insured or covered by UnitedHealthcare Insurance Company or one of its affiliates, a Medicare Advantage organization with a Medicare contract and a Medicare-approved Part D sponsor.
Medicare Made Clear video: Help Your Loved One Choose a Medicare Plan
Medicare Made Clear website: Understand Your Enrollment Periods
Medicare.gov: Medicare Plan Finder tool
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