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A Guide to the 3 Types of Medicare Special Needs Plans in Florida

A Guide to the 3 Types of Medicare Special Needs Plans in Florida.

Did you know that Medicare Advantage plans are more popular with Floridians than any other state? Nearly half of Florida’s 4.6 million Medicare enrollees choose Medicare Advantage over Original Medicare. 

Why do so many Florida residents prefer private Medicare? Medicare Advantage plans can provide more benefits than Original Medicare. This is especially helpful for policyholders who need Medicare special needs plans. 

Special Needs Plans serve members of the population who have health care requirements that go beyond what Medicare Advantage can offer. These plans allow you to customize your benefits to fit your budget, lifestyle, and health needs.

Are you interested in applying for a Medicare Special Needs Plan in Florida? You’re not alone. That’s why we created this guide to everything you need to know—keep reading to learn more!

Medical Special Needs Plans Requirements

Medicare Special Needs Plans (SNPs) are Medicare Advantage plans. That means private insurance companies offer them to individuals who are eligible for Original Medicare. These plans must offer the same benefits as Original Medicare, including:

  • Inpatient and outpatient care
  • Skilled nursing facility (SNF) care
  • Hospice and home health care
  • Lab tests
  • Surgery
  • Medical equipment
  • Some preventative care services

Medicare Advantage SNPs offer even more benefits like dental, hearing, and vision care. You can tailor these additional benefits to the needs of your specific disease or characteristic. 

Here’s what else you need to know about special needs plans. 

Prescription Drug Coverage

Some conditions require prescription drugs. The good news is that all SNP providers are required by law to provide prescription drug coverage.

Networks, Primary Care Providers, and Specialist Coverage

SNPs are Medicare Advantage plans and are similar to traditional HMO or PPO plans in that you must see certain in-network providers to get full coverage for care.

However, there is one exception. When receiving emergency care or if you have end-stage renal disease and require out-of-network dialysis, you can get covered for out-of-network care. 

Most SNPs require you to choose a primary care provider (PCP). Some instead allow you to choose a care coordinator. With a care coordinator, you can access doctors and specialists specific to your condition that you may not have had access to otherwise.

Also like traditional Medicare Advantage plans, SNPs require plan holders to get a referral from a PCP to see a specialist. The exception to this rule includes seeing an out-of-network provider for an annual mammogram. You may also receive coverage for in-network specialists providing bi-annual pap screenings and/or pelvic exams. 

The Three SNPs You Can Get in Florida

In Florida, there are three different types of SNPs you can qualify for:

  • Chronic Condition SNPs
  • Dual-Eligible SNPs
  • Institutional SNPs

Below, we’ll talk about how you can qualify for one of these plans. Plus, we’ll discuss the benefits you can expect to receive from each plan. 

Chronic Condition Special Needs Plans 

Chronic condition special needs plans are also known as C-SNPs. The first requirement for a C-SNP is that you’re enrolled in Medicare Part A and B already. Plus, fi you have one of the following chronic conditions, you can qualify for a C-SNP:

  • Diabetes
  • Cardiovascular disease
  • Chronic heart failure
  • Certain autoimmune diseases
  • Cancer
  • Dementia
  • HIV/AIDS
  • Some other chronic conditions

C-SNPs include prescription drugs. They also include routine dental, vision, podiatry, and hearing care. These plans offer $0 premiums, no deductible requirements, and $0 co-pays. 

Dual-Eligible Special Needs Plans 

Dual-eligible special needs plans are also called D-SNPs. Individuals eligible for Original Medicare Part A and enrolled in Medicare Part B can qualify for a D-SNP. 

To qualify for a D-SNP, you must also be enrolled in Florida’s Medicaid program. Here’s what it takes to be eligible for Medicaid in Florida:

  • You must be a resident of Florida
  • You must be a US citizen, permanent resident, or legal alien
  • You must live in a low income or very low-income household

In Florida, the number of people in your household determines what your max income level can be to qualify as low income. For example, 8-person households can make up to $58,680 per year to qualify. 1-person households can make up to $16,971.

D-SNPs include prescription drug coverage. They also provide dental, vision, and hearing services. Like C-SNPs, these plans have $0 premiums, deductibles, and co-pays.

Institutional Special Needs Plans

Institutional special needs plans are also known as I-SNPs. I-SNPs are reserved for special needs individuals residing in nursing homes, assisted living facilities, or other full-time institutions. You must also already be enrolled in Medicare Part A and Part B. 

Some I-SNPs are HMO plans. This means you must live in an in-network institution. You must also see an in-network provider for care. 

As long as you meet these requirements, you qualify for $0 deductibles and extremely low premiums. I-SNPs also provide prescription drug coverage for all plan holders. 

Let NW Florida Medicare Help You Enroll in a Special Needs Plan

Medicare special needs plans offer customized benefits for individuals with specific conditions. If you have a chronic condition, are enrolled in Medicaid and Medicare, or live in an institution, you can likely qualify for one of Florida’s three SNPs.

Think you’re eligible for one of these SNPs but don’t know how to get started? Get free Medicare advice from NW Florida Medicare. Call us today and let us help you compare SNP costs, find out if you’re eligible, and enroll in the plan that’s right for you.

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