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Medicare Special Needs Plans (SNPs) offer the same Medicare Part A & B coverage that most Medicare Advantage plans cover, but are only available to those who meet certain special qualifications. SNPs may also offer additional benefits.
Dual Eligible Special Needs Plans are available to those eligible for both Medicare and Medicaid. D-SNPs contract with state Medicaid programs to coordinate Medicare and Medicaid benefits and provide equivalent coverage to the Original Medicare benefits of most Medicare Advantage plans. They also provide additional benefits that may include a monthly stipend, prescription drug coverage, dental coverage, and/or medical transportation costs. D-SNPs usually have low or $0 monthly plan premiums.
Chronic Condition Special Needs Plans (C-SNPs) are available for those eligible for Original Medicare (Medicare Parts A & B) who have one or more eligible severe or disabling chronic conditions. See the comprehensive list below for eligible conditions.
For more information or to find a carrier providing C-SNPs, check out CMS.gov.
Institutional Special Needs Plans (I-SNPs) are available for those eligible for Original Medicare (Medicare Parts A & B) who need the level of care a professional facility offers, or live/are expected to live for at least 90 days in a residential health care facility.
For more information or to find a carrier providing I-SNPs, check out CMS.gov.
Coverage | D-SNP | C-SNP | I-SNP |
Charges a monthly premium | Some plans | Some plans | Some plans |
Offers prescription drug (Part D) coverage | Yes | Yes | Yes |
Requires primary care doctor | Some plans | Some plans | Some plans |
Requires specialist referrals | Some plans | Some plans | Some plans |
Offers out-of-network coverage | Some plans | Some plans | Some plans |
Each Medicare Special Needs Plan has different eligibility requirements. However, for any Special Needs Plan, you must have Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), and live in the plan’s service area.
For a Zing Health Dual Eligible Special Needs Plan (D-SNP), you must qualify for both Medicare and Medicaid and live in select counties in Michigan.
Medicare eligibility: By age: If you are a United States citizen who has been living in the U.S. for the past 5 years and are 65 years of age (or nearing your 65th birthday), you are eligible for Original Medicare (Parts A & B). By special circumstance: Some disabilities and conditions may qualify you for Medicare coverage before age 65:
To qualify for a Zing Health Chronic Condition SNP (C-SNP) you must have one or more of the following severe or disabling chronic conditions:
To qualify for an Institutional Special Needs Plan (I-SNP) you must live or expect to live for at least 90 days in a residential health care facility such as the following.
How do I enroll in a SNP?
Healthcareplans.com works with carriers such as UnitedHealthcare®, WellCare, Humana, and more. If you are eligible for a Special Needs Plan, research plans online and shop during a qualifying enrollment period. At Healthcareplans.com, you can use our tools to shop for Dual Eligible Special Needs Plans only; to find resources for C-SNP and I-SNP carriers, visit CMS.gov.
When do I enroll in a SNP?
If you are qualified for a Special Needs Plan, enroll during the following qualified Medicare Enrollment Periods:
Do SNPs charge a monthly premium?
Special Needs Plan costs vary by carrier and location, but many SNPs feature low or $0 monthly premiums, copays, and deductibles. For D-SNPs specifically, Medicaid benefits from the state generally cover most or all of your out-of-pocket costs.
Do I need to pick a primary care physician (PCP)?
Plans from some carriers require you to choose a primary care physician and others do not. It will depend on the carrier and specific plan you choose; be sure to check before you sign up.
Do I have to get a referral to see a specialist?
Plans from some carriers require you to have specialist referrals and others do not. It will depend on the carrier and specific plan you choose; be sure to check before you sign up.
Can I choose a separate Medicare Advantage (Part C plan) with my SNP?
The coverage provided by your Special Needs Plan is equivalent to the coverage you’d get with a Medicare Advantage (Part C) plan; there is no need to enroll in a separate plan.
Learn about the two Medicare enrollment periods that run from January through March.
When is the Medicare Annual Enrollment Period? Get answers to this and other AEP-related questions.
Get fast facts about Medicare Enrollment, including when you qualify and when to enroll.
Clearlink Insurance represents Medicare Advantage HMO, PPO, PFFS, and PDP organizations that have a Medicare contract. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
We do not offer every plan available in your area. Currently we represent 7 organizations which offer 275 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
Enrollment in a plan may be limited to certain times of the year unless you qualify for a Special Enrollment Period or you are in your Medicare Initial Enrollment Period.
For accommodations of persons with special needs at meetings call TTY 711.
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