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Special Needs Plans Offer Customized Medicare Options for Chronic Care

Zing Health
Posted by Zing Health on Dec 16, 2022 4:33:28 PM

Medicare beneficiaries may receive extra support and benefits to help with diabetes care, heart conditions and other long-term illnesses. Having a new and serious health diagnosis is not only stressful, but it can also strain the bank account. So, it’s worth knowing that specific plan types called special needs plans can with better health outcomes and management of chronic conditions.

Special needs plans are customized Medicare Advantage plans that combine overall hospital and medical coverage with additional services and prescription drug coverage to address ongoing medical needs, avoid complications and help with daily activities. Living with a chronic disease can be easier with access to medical specialists, special equipment, prescription drugs and coaching to achieve a better quality of life.

Help With Care Coordination and Prescription Medications

Dealing with long-term problems can be frustrating. A Chronic Condition Special Needs Plan (C-SNP) provides specially trained personnel who know what their members are going through. Care coordinators are in regular contact to help improve their health. With many providers involved, they work with primary care doctors, specialists, and hospital staff to manage care transitions. They help schedule appointments, may arrange transportation, and follow up on treatment plans. Care managers resolve issues and provide referrals and training to improve members’ general well-being.

C-SNP plans may also provide affordable prescription drug coverage, which is vital to managing chronic conditions. They may include Medicare Part D prescription drug coverage with a specialized formulary designed to meet certain chronic conditions. Care coordinators will work with members to review medication changes, make sure they’re taken at the right time and help address new symptoms.

For instance, doctors may prescribe insulin and other medications for diabetes care and may recommend continuous glucose monitoring devices to help their patients keep blood sugar in a safe range. A C-SNP plan may provide enhanced coverage for these treatments, plus coaching on how to manage the devices and alter their diets to avoid spikes in blood glucose levels.

A C-SNP plan also may include specialized supplemental benefits designed to serve the specific needs of its members. For instance, members under care for heart conditions or diabetes may benefit from weight management programs to reduce their risk for hypertension or improve their blood sugar control.

When to Apply for a Special Needs Plan:

During the Annual Enrollment Period for Medicare-eligible people, beneficiaries should carefully examine current health benefits regardless of their existing coverage. With some exceptions, any changes beneficiaries elect to make with their choice of health plan should be made during this time.

If you are not yet 65, but will be soon:

This is the one-time people turning 65 do not need to concern themselves with the Annual Enrollment Period. This is because people in this category have their Initial Coverage Enrollment Period (ICEP), which spans from three months before their 65th birthday through the month of their birthday and the three months following it. It’s vital that people who are approaching or are in their ICEP to learn all they can about their options. There are many resources for seniors to get help and advice in this area.

This is even more impactful for those with chronic conditions that qualify them for a Special Needs Plan. These plans are not all the same, and exclusively provided by Medicare Advantage Organizations (MAOs).

If you have any kind of Medicare coverage or are eligible and are newly diagnosed with diabetes or other chronic conditions:

Whenever a qualifying condition is diagnosed, it triggers a Special Election Period allowing a beneficiary to choose a different health plan. The new health plan may have better coverage, lower prescription costs or services to help manage the condition more effectively. It is not necessary to wait for other enrollment periods.

The new diagnosis creates a unique, one-time window. People in this category often find it’s a great help to enroll in a C-SNP plan with a Medicare Advantage carrier. It’s important to study notices about any changes. Coverage and costs in Medicare Advantage plans can vary greatly and may also change year to year. Finding the right plan and keeping up with its options will assure members have the resources to stay in the best health possible.


Topics: Medicare Advantage, Blog, chronic conditions, Annual Enrollment Period, AEP, CSNP, heart, diabetes

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