Ask These 3 Questions to See if Clients May Qualify for SNPs

Posted by Paul Rose on 6/24/20 9:37 AM


A lot can change in a year, or even a month. If your clients have experienced major changes in their health or finances, their current Medicare plan may no longer fit their needs. 


The good news is that Medicare Special Needs Plans (SNPs) can help beneficiaries in these situations. Even better, your clients may not have to wait until the next Annual Election Period (AEP). Special enrollment periods allow eligible beneficiaries the opportunity to enroll anytime of the year. 


SNPs are Medicare Advantage plans that are only open to individuals who meet the criteria for that plan. All SNPs include prescription drug coverage, and many provide additional benefits designed to help their members.  


Enrollment in SNPs is allowed throughout the year for eligible beneficiaries. When enrollees no longer meet the criteria for a plan, they will have to leave the plan, but they will be given another special enrollment period to enroll in another plan.  


Ask these three questions to see if your clients may qualify: 


Question #1:  Have You Been Diagnosed with a Chronic Condition? 


Chronic Condition Special Needs Plans (C-SNPs) serve beneficiaries with certain chronic health conditions. Different C-SNPs cater to different illnesses, including diabetes, cancer, stroke, cardiovascular disorders and other chronic conditions.  If any of your clients have been diagnosed with a chronic condition, check to see if there are any C-SNPs in the coverage area that cater to that condition.  


Question #2:  Have You Moved into a Nursing Facility? 


Institutional Special Needs Plans (I-SNPs) cater to beneficiaries who live in a nursing home or other institution. Beneficiaries who require nursing home care may also qualify for enrollment in an I-SNP. 

If any of your clients require nursing care at home or in an institution, see what I-SNPs are available in the area. 


Question #3:  Have You Become Eligible for Medicaid? 


Dual Eligible Special Needs Plans (D-SNPs) cater to individuals who are eligible in both Medicaid and Medicare.  Medicaid eligibility varies from state to state and is based on factors including income. In order for the beneficiary to apply for Medicaid, they will need to contact the state Medicaid office. Beneficiaries can also see if they qualify through the Health Insurance Marketplace. 


Enrollment in two programs (Medicare and Medicaid) at the same time can get complicated, but D-SNPs simplify coverage and help ensure that eligible enrollees don’t pay more than they should. If any of your clients are eligible for both Medicare and Medicaid, see what D-SNPs are available in the area.  


Check in with Your Clients 


Don’t wait until the next annual election period. If your clients have experienced health or financial changes, they may not realize that help is available. Check in with your clients to see if their needs have changed. If they do in fact need a new plan, see if they qualify for a special enrollment period to join a special needs plan.  

Topics: Special Needs Plans, SNP, SNP's

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