Medicare Advantage Special Needs Plans

Medicare Advantage Special Needs Plans

Medicare Advantage Special Needs plans are a set of Medicare Advantage plans that serve individuals with unique needs. 

To be eligible for these plans you must be enrolled in Medicare Parts A and B and meet the specific eligibility requirements the plan has.

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Types of Medicare Advantage Special Needs plans

There are three types of Special Needs plans:

  • Chronic-Condition Special Needs Plan — This plan is for Medicare beneficiaries with disabling chronic conditions such as certain autoimmune diseases, cancer, cardiovascular disorders, dementia, HIV/AIDS, and other chronic conditions.
  • Dual-Eligible Special Needs Plan — This plan is for those who have both Medicare and Medicaid benefits.
  • Institutional Special Needs Plan — This plan is for those who live in an institution, like a nursing home, or who require nursing care at home.

If you think you qualify for one of these plans and want to be sure of your eligibility, reach out to one of our licensed Medicare insurance agents and they can confirm your eligibility and provide you with a quick and free quote.

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Medicare Advantage Benefits

Medicare Advantage Special Needs plans are required by Medicare to provide the same benefits of Parts A and B. That is inpatient hospital care, skilled nursing facility, hospice, lab tests, surgery, home health care, outpatient care, medical equipment, and some preventative services. 

However, Advantage plans can provide additional benefits like: 

  • Adult day-care services
  • Dental
  • Fitness memberships
  • Hearing
  • Nutrition programs
  • Over-the-counter drugs
  • Services and supports for those with chronic conditions
  • Transportation to doctor visits
  • Vision
  • Wellness programs

Also, some Special Needs plans include care-coordination services specific to your chronic condition. Services such as wellness plans to help you understand and follow your special diet or other activities that help improve or manage your condition. You may also have access to doctors or hospitals that specialize in your chronic condition. 

Another major benefit that separates Special Needs plans from other Medicare Advantage plans is that it is required to include prescription drug coverage. 

Benefits you are eligible for will depend on your area and plan providers.

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When you can enroll

If you are eligible for Medicare, you are eligible for an Advantage plan. But there are specific times in which you can enroll:

Initial coverage election period — Your initial coverage election period is a seven-month period that starts three months before the month you turn 65 and ends three months after the month you turn 65. If you are under 65 and receive Social Security disability, you qualify for Medicare in the 25th month after you begin receiving your Social Security benefits. If that is how you are becoming eligible for Medicare, you can enroll into an Advantage plan three months before your month of eligibility until three months after you became eligible. 

Annual election period — Also known as open enrollment or AEP, the annual election period for Medicare Advantage is October 15 through December 7 every year. Coverage for the Part C plan you choose during this time will begin January 1 the next year. During this time, you can also add, change, or drop current coverage.

Medicare Advantage Open Enrollment Period — During this open enrollment period, you are able to change from one Advantage plan to another or drop it to return to Original Medicare.

Special Election Period — There are several things that can trigger a special election period and they are unique to an individual. It is best to speak to a licensed Medicare insurance agent to find out if you qualify for a special election period. However, there are a few common instances we can talk about. Such as, if you move outside your Medicare Advantage plan’s service area, qualify for extra help (such as a program that helps pay for your prescription drugs), or move into a nursing home you might qualify for a special election period. During this time you can make changes to your Advantage plan or return back to Original Medicare.

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