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Overview of Medicare Advantage Special Needs Plan

Overview of Medicare Advantage Special Needs Plan

Medicare Special Needs Plans (SNPs) are offered by private companies to provide Medicare Part C to certain groups of people qualified for Medicare. The companies offering these plans must be approved by Medicare. All Medicare Special Needs Plans must also include Prescription Drug (Medicare Part D) coverage.

Special Need Plans are usually health maintenance organization (HMOs) or preferred provider organizations (PPOs). Enrollment in Special Needs Plans is limited to people with qualifying diseases and circumstances.

A Special Needs Plan covers virtually all the health care needs of its members. The idea is that these plans can tailor the benefits, health care provider choices, and list of prescription drugs to fit the special needs of people with a specific, serious disease or other circumstances.

According to Your Guide to Medicare Special Needs Programs , there are three types of Special Needs Plans.

  1. Chronic Disease Special Needs Plans

    These plans may be available to qualilfied individuals with serious and/or disabling health conditions. The list of diseases that may make you eligible for one of these plans includes:

    • Chronic alcohol and other drug dependence
    • Autoimmune disorders
    • Cancer (excluding pre-cancer conditions)
    • Cardiovascular disorders
    • Chronic heart failure
    • Dementia
    • Diabetes mellitus
    • End-stage liver disease
    • End-Stage Renal Disease (ESRD) requiring any mode of dialysis
    • Severe hematologic disorders
    • HIV/AIDS
    • Chronic lung disorders
    • Chronic and disabling mental health conditions
    • Neurologic disorders
    • Stroke
  2. Institutional Special Needs Plans
    • These plans may be available to eligible individuals who live in a nursing home or need a nurse to care for them in their home.
  3. Dual Eligible Special Needs Plans
    • These plans may be available to people who are eligible for both Medicare and Medicaid.

Y0071_14_18467_I 10/03/2013
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Empire BlueCross BlueShield is an HMO Health plan with a Medicare contract. Enrollment in Empire BlueCross BlueShield depends on contract renewal. Empire BlueCross is an HMO plan with a Medicare contract. Enrollment in Empire BlueCross depends on contract renewal.
Services provided by Empire HealthChoice HMO, Inc. licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.

Empire BlueCross BlueShield is an LPPO plan with a Medicare contract. Enrollment in Empire BlueCross BlueShield depends on contract renewal. Empire BlueCross is an LPPO plan with a Medicare contract. Enrollment in Empire BlueCross depends on contract renewal.
Services provided by Empire HealthChoice Assurance, Inc. licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans.

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