Opuscula A Funny thing About “SNP” Medicare Plans

AS I WAS RESEARCHING MEDICARE ADVANTAGE plans, I discovered something “interesting.”
Some “SNP” plans can cost more than “regular” advantage plans.

JUST WHAT ARE “SNP” plans? (That’s redundant, by the way.)

SNP stands for “Special Needs Plans.”

Who is eligible for SNPs

According to Medicare¹,

A special needs plan (SNP) is a Medicare Advantage (MA) coordinated care plan (CCP) specifically designed to provide targeted care and limit enrollment to special needs individuals. A special needs individual could be any one of the following:
1. An institutionalized individual,
2. A dual eligible, or
3. An individual with a severe or disabling chronic condition, as specified by CMS.

People certified as “Special Needs” can supplement Medicare with their state’s Medicaid program.

MediCARE vs. MediCAID

The Health and Human Services (HHS) web site² provides definitions for the two programs.

That begs the question, “What is a “dual eligible.”

Medicade.gov³ provides part of the answer:

Medicaid is a joint federal and state program that, together with the Children’s Health Insurance Program, provides health coverage to over^cq 72.5 million Americans, including children, pregnant women, parents, seniors and individuals with disabilities. Medicaid is the single largest source of health coverage in the United States.
In order to participate in Medicaid, federal law requires states to cover certain groups of individuals. Low income families, qualified pregnant women and children, and individuals receiving Supplemental Security Income (SSI) are examples of mandatory eligibility groups. States have additional options for coverage and may choose to cover other groups, such as individuals receiving home and community based services and children in foster care who are not otherwise eligible.

 PolicyGenius⁴ reports that

Medicaid requirements were standardized so any American making as much as 133% of the poverty line could qualify.

The same site lists general requirements for SNP recipients.

As a good rule of thumb, if you make less than 100% to 200% of the federal poverty level (FPL) and are pregnant, elderly, disabled, a parent/caretaker or a child, there’s likely a program for you. And if you make less than 133% of the FPL, there’s possibly a program for you, depending on whether your state expanded under Obamacare. In 2018, the FPLs (in all states except Alaska and Hawaii, which have higher guidelines) are:

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I only checked one Medicare Advantage site’s SNP program. Still, I found it strange that a program designed to help the impoverished has a pharmacy deductible that non-SNP options lacked, particularly when medications are a major expense for the people covered by a SNP.

There ARE some no co-pay benefits that make the Special Needs Plans attractive, and what I saw were only the provider’s highlights; I did not check the plan’s Evidence of Coverage – the document that lists all benefits and co-pays.

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Sources

1. http://tinyurl.com/yal6zpcn

2. http://tinyurl.com/yczr3jkg

3. http://tinyurl.com/y7ymx8rz

4. http://tinyurl.com/ya8nvdq4

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