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Help for the Most Vulnerable is Available with Special Needs Plans By Gateway Health
The Choice is Not Always Simple

Are you 65 or older and looking for the best Medicare plan? Are you chronically ill or disabled and worried about how you are going to pay for your medications? When living with a chronic condition or on a fixed income, it can be daunting to choose one health plan among many. Do you worry that you may be running out of time? If you have asked yourself any of these questions, a Special Needs Plan (SNP) may be just what the doctor ordered. But what are SNPs exactly?

According to the U.S. Centers for Medicare and Medicaid Services, nearly nine million of Medicare's 49 million beneficiaries also qualify for Medicaid. That means they qualify for dual benefits from both agencies. Another fifty percent (50%) of the Medicare population live with one or more chronic conditions. The vast majority of these beneficiaries may qualify for one of the three types of SNPs created by the Medicare Modernization Act of 2006:

The first type is called the dual eligible SNP. These Medicare Advantage health plans are for beneficiaries who qualify for Medicare Parts A and B, plus some assistance from the State in the form of Medical Assistance (Medicaid). Those eligible for dual eligible SNPs can enroll at any time throughout the year, not just during the fall Open Enrollment period.

The next type is a chronic condition SNP. These Medicare Advantage health plans are for people with a chronic or disabling condition. The goal of this type of SNP is to better coordinate care while improving the quality of life of members enrolled in the plans. Beneficiaries can join these plans throughout the year if they have never been enrolled in a chronic condition SNP.

The final type caters to Medicare beneficiaries living in nursing homes and other long term care settings. They are called institutional SNPs.

There are plenty of SNPs available that offer all of the original benefits of Original Medicare with added benefits, such as free fitness club memberships, dental benefits, reduced copays and coinsurance, bathroom safety products, and additional hearing and vision aids.

How Do I Select the Right SNP?
Prepare a list of essentials you are looking for. Use a tool such as the Medicare plan finder to narrow your choices to the top two or three based on your list. It is important to contact the plans that you are most interested in to be certain you meet the plan's eligibility criteria.

Pay attention to the plan premium. Every plan is different, but there are lots of SNPs that offer extra benefits for no added monthly premium.

Compare copays and any added out-of-pocket costs across plans. You may be expected to pay the Medicare Part D prescription drug plan's co-pays, which will vary from plan to plan.

Note also that insurance companies may offer more than one plan in an area, with different benefits and costs.

The Importance of Coordinated Care
When people with chronic diseases are not cared for properly, all too often they are left to navigate the healthcare system on their own. This leads to poorer heath outcomes and disjointed healthcare services. To help tackle this issue, some Medicare SNPs use a care coordinator to help you stay healthy and follow your doctor's orders. A care coordinator is someone who helps make sure people get the right care and information when they need it.

For example, a Medicare SNP for people with diabetes might use a care coordinator to help members monitor their blood sugar, follow their diet, get proper exercise, schedule preventive services such as eye and foot exams, and get the right prescriptions to prevent complications. A Medicare SNP for people with both Medicare and Medicaid might use a care coordinator to help members access community resources and coordinate their different Medicare and Medicaid services. Many health plans in this category offer transportation services, which are essential for maintaining optimal health.

Where Can I Find a SNP?
Here's how you can find a Medicare SNP in your area:

Look at the "Medicare & You" handbook that is mailed to you each fall. The Medicare SNPs in your area are listed in the back.

Visit www.medicare.gov/find-a-plan. If you don't have a computer, your local library or senior center may be able to help you access the Medicare website.

Call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.

Call the health plan of your choice directly, or visit their website to find out more about the plan's benefits and list of coverage.

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