Applicable Conditions for a Special Needs Plan
The eligibility situations covered by SNPs can be divided into three categories: chronic conditions, institutonal treatment, and dual eligibility.
Chronic SNP coverage applies to the following:
- Alcohol or chemical dependency
- HIV/AIDS or other autoimmune diseases
- Chronic heart failure
- Liver disease
- End-Stage Renal disease
- Debilitating blood disorders or disease
- Chronic respiratory problems
- Mental health conditions
- Strokes and related recovery
Institutional SNPs are used for subscribers in nursing homes, inpatient psychiatric facilities, and for facilities treating intellectual disabilities.
Dual Eligibility SNP coverage applies to individuals with Medicare and Medicaid coverage.
Ask your insurance provider about which coverage option will fit your healthcare needs.
Do I Have to Have a Primary Care Physician?
Similary to PFFS and PPO plans, most Special Needs Plans do not require you to have a primary care physician, some plans may require you to declare one. Usually though, if a plan does not require a PCP, they will require you to have a care coordinator. A care coordinator ensures you are receiving all the care covered by your plan. Specifically, care coordinators help you get all doses of prescriptions, exercise, monitor blood sugar, and follow diets. If you have any questions about your SNP coverage, contact one of our insurance agents and find answers today!