SNPs and SEA

Atherosclerosis and Medicare Special Needs Plans


Any person that has been diagnosed with a chronic disease may be able to benefit from a special needs plan offered by Medicare. These plans were created to help people suffering from certain diseases or medical conditions. When a person is included in a special needs plan, he or she will be provided coverage for hospital stays, office visits, medication, as well as other Medicare covered services.

But what should a person do in order to benefit from such a plan? First of all, that person must have a Medicare Part A and Part B, and the person has to live within the plan’s service area. When these conditions are met and the person is also diagnosed with a severe or disabling chronic condition, or lives in a nursing home, he or she may be elected as a beneficiary of a special needs Medicare plan.

A Medicare SNP will help the patient better coordinate all the treatment steps, as well as have access to the necessary diet and the proper medication schedule. Every special needs plan is tailored to the direct benefit of the diagnosed person, so that the special needs of that person are completely met.

The SNP will also help provide a care coordinator, a person that is trained and specifically trained, being able to determine the patient’s medical condition and special characteristics, in order to see if there are changes that have to be reported. This coordinator can also connect the person to the community services that are available in the patient’s neighborhood. A coordinator will also help the patient follow the medical instructions, get the medical treatment on time and provides all the needed information.

SNP covers about 15 medical conditions like cancer, heart disease, diabetes, dementia, lung disease and end stage liver diseases or kidney diseases. Such plans will provide care for people with one or multiple, severe diagnostics.

The price for such a coverage depends on the number of times one may need special care and, of course, the type of care one may need. The price one may be asked to pay will consist of Medicare Part B premiums and deductibles, coinsurance or copays. Specialists say that in some cases the patient may also need to pay a SNP premium.

Medicare SNP has a network of specialists that the patient needs to work with. This network includes doctors, specialists, hospitals and other medical care providers. Even if the patients have signed a SNP, but they do not like the quality of care they are receiving, they may change the plan or simply give up. When the patients are no longer eligible for a SNP, they can always join another Medicare plan or go back to the original plan they have had.

Medicare SNP also covers prescription drugs which can help patients with severe, chronic medical conditions. Some people fear that the SNP may not include a special service that they may need. The good news is that if a medical service is considered to be necessary under the Original Medicare plan, then it must be included in the Medicare SNP as well. The plans do not cover for services that Medicare does not consider to be necessary, of course. When a patient wants to have access to a special medical service that is not covered by the SNP, then the patient needs to fully pay for that service in order to benefit from it.

Patients that want to benefit from a SNP need to have a primary care doctor. When there is no such person, the patient will be helped by a coordinator.

Not only people with severe medical conditions benefit from SNP. People that live in institutions like nursing homes or persons that require nursing care at home may qualify for Institutional SNP. Another category is the one that includes people that have both Medicare and Medicaid.

Every year there are different types of Medicare SNPs that are offered to people all over the country. The insurance companies decide what states and counties they will target, so the SNPs may not be available in every corner of the country. There have been situations when a certain plan was available for every person with Medicare, but there were also some other types of plans that were only available in certain counties.

As a conclusion, the Medicare SNP does not eliminate the Original Medicare plan, but provides extra care for those that are suffering from severe chronic medical conditions.

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