Medicare Advantage Special Needs Plans (SNPs)
Special Enrollment Period

March 25, 2015

Medicare Special Needs plans are a type of Medicare Advantage plan for people who receive both Medicare and Medicaid (also referred to as “dual eligible”), live in an institution, or who have certain chronic conditions.

Special Needs plans:

• Combine all the benefits of Original Medicare (Parts A and B) with prescription drug coverage (Part D).
• Many plans have a $0 to low monthly premium* beyond what you pay for Part B. Depending on the specific plan,
• Benefits may also include care coordination,
• Routine vision and dental coverage,
• Some plans offer transportation to medical appointments.

*In a dual eligible special needs plan, the premiums, copayments, coinsurance and deductibles vary based on income and Medicaid status.

Pre-Enrollment Verification Process

Chronic Illness Special Needs Plan

You can only enroll consumer who have one of the qualifying illnesses into a Chronic Care Special Needs Plan (CSNP). Prior to completing an enrollment application, the agent must complete a review of the chronic inness plan and determine the consumer’s eligibilty. If the beneficiary is elegible and chooses to enroll, the agent must complete the enrollment application and submit the required chronic illness authorization form. Consumers are only enrolled in the plan after their chronic illness has been verified by a physician’s office.

Dual Eligible Special Needs Plan

Beneficiaries who have both Medicare and Medicaid may be enrolled in a Dual Eligible Special Needs Plan (DSNP). Prior to completing an enrollment application, the agent must complete a review of the DSNP and determine the consumer’s eligibility. If the individual is eligible for the DSNP and chooses to enroll, the agent will complete the enrollment application and include the beneficiary’s Medicaid number. The beneficiary will be enrolled in the plan after their Medicaid status has been verified.

As always, we thank you for your support and cooperation. For questions or comments, please email us at Compliance@NSGACommunications.com or you may call the toll-free number listed below.

FOR AGENT USE ONLY. NOT FOR USE WITH CONSUMERS.

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