What Is A Special Needs Plan (SNP)?
A Special Needs Plan (SNP) is an HMO with membership restricted to individuals who meet the plan’s eligibility requirements.
Generally, membership in an SNP is limited to those who are dual-eligible for both Medicare and Medicaid, those who live in a long-term care facility or other institution, or those with specific health conditions.
SNPs gear their benefits to best suit the health needs of their members. For example, an SNP for people with diabetes would likely include endocrinologists as primary care providers. It might also cover podiatry services, dietician visits, and weight management counseling. The plan’s formulary would include most medications used to treat diabetes.
Most SNPs also have case managers or care coordinators assigned to each enrollee in order to make sure members are getting the treatment and services they need.
Medicare Advantage vs Original Medicare
Because Medicare Advantage is private insurance, people mistakenly believe that they lose some of the benefits offered with Original Medicare. This not the case, however. The Centers for Medicare and Medicaid Services (CMS) requires that all Medicare Advantage plans cover everything that’s covered by Part A and Part B.
In fact, most Medicare Advantage plans in NJ go beyond Original Medicare, providing benefits for services Original Medicare doesn’t typically cover. For example, nearly all New Jersey Medicare Advantage plans cover routine dental, vision, and hearing care. Most also have some type of fitness benefits, like a SilverSneakers membership.
Some Medicare Advantage plans have added new supplemental benefits, which first became available in 2019. These benefits include coverage for things such as meal and grocery delivery, non-medical transportation, home safety modifications, and certain over-the-counter medications and devices.
This is all great news, meaning that you’re not missing out on any benefits or protections if you enroll in Medicare Advantage plans NJ. Also, while enrolled in these plans, the Medicare Patient’s Bill of Rights still applies to you, and you have avenues for appeal if you disagree with any decisions made by your plan.
Medicare Advantage Plans NJ Costs
It is important to know that when you enroll in Medicare Advantage, you still have to pay your Part B premium. You may also have an additional premium for your Medicare Advantage plan. However, if your plan includes a Part D prescription drug plan, you won’t pay an extra premium for that coverage.
Most Medicare Advantage plans in NJ go beyond Original Medicare, providing benefits for services Original Medicare doesn’t typically cover.
Many plans have an annual deductible, but you pay it only once a year. Also, there is only one deductible with Medicare Advantage, compared to the separate deductibles for Part A and Part B. There may be a separate deductible for Part D prescription drug coverage.
All Medicare Advantage plans have an annual out-of-pocket maximum. The cost varies from plan to plan, but it can’t exceed the annual limit set by CMS. For 2020, the out-of-pocket maximum is $6,700. According to the Kaiser Family Foundation, the average out-of-pocket maximum for Medicare Advantage HMOs is $4,925.
Most Medicare Advantage plans in NJ use a copayment for cost-sharing. This means that you pay a flat fee when you get care, regardless of the actual cost of your visit.
Medicare Advantage Costs At A Glance