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Have Things Changed for Your Clients? Ask Three Questions to Determine SNP Eligibility

Posted by Paul Rose on 7/12/21 9:20 AM

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We’ve seen just how much can change in a year. From finances to health, major shifts can happen overnight. If your clients have experienced a change in their situation, their current Medicare plan may no longer suit 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?

According to Skilled Nursing News, referrals to nursing homes dropped during the pandemic. However, now that vaccines are being rolled out, occupancy may start getting back to normal.

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.

D-SNPs simplify coverage and help ensure that dually 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.

People who are eligible for both Medicare and Medicaid can switch plans four times a year: once between January and March, once between April and June, once between July and September and once during AEP.

Check in with Your Clients

Don’t wait until the next AEP. 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, SNP Eligibility

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