| Mon, Dec 20, 2010 @ 09:00 AM

Medicare Coordinated Care: Special Needs Plans 101

Posted by Medicare Made Clear

Medicare Coordinated Care PlansMedicare Special Needs Plans are a specific type of Coordinated Care Plan for Medicare beneficiaries. These plans are designed to help those with special needs receive well-coordinated care. They combine hospital care, doctor’s visits and other outpatient care in a single plan. Some plans even include the help of a care manager or a nurse practitioner who serve as an advocate for the patient, ensuring that he or she receives the care they need.

Who is eligible for a Medicare Special Needs Plan?

People who are eligible for a Special Needs Plan must fall under one of the following groups:

  • Those who are in a nursing home of other long term care facility because they are unable to care for themselves.
  • Those who are eligible for both Medicare and the Medicaid assistance program.
  • Those with certain chronic diseases such as diabetes and/or heart disease.

Some Special Needs Plans serve people who are institutionalized or people who are eligible for both Medicare and Medicaid (sometimes called “dual eligibles”). A few plans available are designed to help patients deal with chronic conditions like diabetes.

Special Needs Plans are offered by private insurers who provide care through a designated network of doctors and hospitals.

How to Choose a Special Needs Plan

Because each plan has an individual network of doctors and hospitals it’s important to review the network for each plan you’re considering. Be sure the doctors and hospitals you prefer are included. Each plan will have different coverage benefits and have different eligibility requirements, so it is important to contact the plan providers to determine for certain if you are eligible.

Contact your local Social Security Office today if you’re interested in learning more about the Special Needs Plans in your area.

Additional Resources

http://www.medicare.gov/Publications/Pubs/pdf/11302.pdf

http://www.healthcarefinancenews.com/news/medicare-special-needs-plans-cover-15-conditions-2010

http://aspe.hhs.gov/daltcp/reports/2009/leghist.htm

The family of UnitedHealthcare® Medicare Solutions plans are insured or covered by an affiliate of UnitedHealthcare, a Medicare Advantage organization with a Medicare contract and Medicare-approved Part D Sponsor.

Y0066_101214_165127 File & Use 12202010