Medicare Advantage for those with special needs

If you have decided to join a Medicare Advantage Plan, you may benefit from a Medicare special needs plan, if you meet the plan’s qualifications. As with all Medicare Advantage Plans, you must live in the plan’s service area and be enrolled in Medicare parts A and B. You also must not have end-stage renal disease at the time of enrollment.

In addition to meeting the general requirements to enroll in a Medicare Advantage Plan, you must also meet the specific qualifications for each type of special needs plan as defined by the plan type you wish to join.

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Types of Medicare special needs plans

Types of Medicare special needs health plans include:

• Health plan for people with limited incomes. These plans are for people that are considered to be dual eligible. Dual eligibility means that the person is enrolled in both Medicare and qualifies and is enrolled in their State’s Medicaid program. Medicaid offers additional assistance to people who qualify due to having a low income as defined by their State of residency. Plan’s typically offer services with extremely low or no co-pays for services. Part D prescription drug coverage is included as are extra benefits beyond what original Medicare offers. Extras may include transportation for appointments with medical providers and trips to the pharmacy.
• Health plan for people with specific long term illnesses. This type of Medicare special needs plan is considered to be a chronic illness special needs plan. It is designed to meet the needs of those with specific enrollment criteria, as defined by their having a qualifying chronic illness. Plans may include; cardiovascular disorders, chronic heart failure, diabetes and other qualifying disorders. These plans typically offer a higher level of coordinated care than other Medicare Advantage Plans. Part D is generally included as are extra benefits designed with the member’s condition in mind. The treating physician will generally have to verify the condition indicated on the application, as the qualifying condition for enrollment, with the plan provider.
• Health plan for people in nursing homes. The key to eligibility for this plan is residency in a nursing home. The residence must be a qualified nursing home. This is generally for people permanently residing in a nursing home, and not receiving temporary respite care. Services are highly coordinated and may include the services of a nurse practitioner. Part D is included, as are additional benefits, such as transportation. These plans have little or no co-pays for services, as many that are qualified are also dual eligible qualified.

Enrolling in Medicare special needs plans

Enrolling in a special needs plan is different than enrolling in a non-special needs Medicare Advantage Plan. When enrolling in Medicare special needs plans, individuals are not limited by the standard annual and open enrollment periods. People who qualify for one of these plans are able to enroll at any time. Qualifying for a plan qualifies them for a special enrollment period by default.

If you qualify for one of these types of Medicare special needs plans, you should consider the benefits of enrolling in one. Your costs may be lower and your benefits enhanced as a member of the plan for which you qualify.