A special kind of coordinated care plan exists called a Special Needs plan. These are a unique kind of Medicare Advantage plan offered by private insurance companies for certain qualified individuals.
A person who lives in a contracted assisted living facility and needs the same kind of care as those who live in a skilled nursing facility may qualify for an Institutional-Equivalent Special Needs plan (IE-SNP). This is still considered an I-SNP.
Special Needs plans cover the same health care services that all Medicare Advantage plans must, including Medicare Part A and Part B. Some SNPs may also cover extra services tailored to the specific group they're designed to serve; however, all Special Needs plans are required to provide prescription drug coverage. You'll want to review each plan you may qualify for carefully to learn exactly what benefits and services will be covered.
Dual Special Needs plans (D-SNPs) are for people who have both Medicare and Medicaid (called "dual eligible"). A Dual Special Needs plan is a unique Medicare Advantage plan that combines your Medicare Part A and Part B benefits, and your Medicare Part D prescription drug coverage. You'll get extra support to help coordinate the plan with your Medicaid plan. In addition, a dual health plan provides extra benefits not provided by either Medicare or Medicaid.
Who qualifies for a Dual Special Needs plan?
To qualify for a D-SNP, you must receive Original Medicare (Parts A and B) and full Medicaid benefits. Depending on the amount of Medicaid benefits you receive, you may be considered a "full dual-eligible" or a "partial dual-eligible." If you receive full Medicaid benefits, you will be fully dual-eligible. Most of the time, individuals who qualify get a letter from their state Medicaid office. You can also call to find out your status.
Dental, vision and hearing coverage, care coordination via a personal care coordinator, personal emergency response system (PERS), tele-health options such as virtual medical visits with your doctor, credits to buy health products, plus transportation assistance and more. These are just a handful of examples of the extra benefits Dual Special Needs plans typically include. Each plan is different, so be sure to look at what's available where you live.
A Dual Special Needs plan doesn't replace your Medicaid plan or change your Medicaid eligibility. You'll keep the same Medicaid plan you have today, and you'll still get all the same Medicaid benefits you get now.