Medicare, Medicare Advantage, and Special Needs Plans Explained
For those who are 65 or older, choosing the right health insurance can seem overwhelming. Medicare, Medicare Advantage, and Special Needs Plans offer many options, and the lingo can make it confusing. To be as clear as possible, let’s start at the beginning.
What is Medicare?
Medicare is federal health insurance for people 65 or older, and for some people under 65 with certain disabilities or health issues. It’s run by the Centers for Medicare and Medicaid Services.
Medicare has four parts, or plans, to provide a full line of services:
- Part A which includes hospital coverage.
- Part B which includes medical coverage.
- Part C which combines Part A and Part B and has additional coverage. It’s most often referred to as Medicare Advantage.
- Part D which includes prescription drug coverage.
Because there’s Medicare and Medicare Advantage, Medicare is often called the “original” Medicare.
What are the advantages of Medicare Advantage?
A Medicare Advantage plan is like a one-stop shop. It combines all the services of Part A and Part B, and usually includes prescription drug coverage, which means there isn’t a need to get a separate Part D plan.
Medicare Advantage also offers additional benefits that can include coverage for dental, vision, hearing, and other wellness services.
Medicare Advantage plans offer primary care and preventive services, care coordination, case management, and other services to improve care quality, with a focus on those with long-term or chronic health conditions.
With Medicare Advantage, there’s a limit on out-of-pocket expenses for:
- Deductibles (the amount you pay for covered healthcare services before your insurance starts to pay).
- Coinsurance (the amount you pay for covered healthcare services after you’ve paid your deductible).
- Copays (a fixed amount, for example $20, you pay for a covered healthcare service after you’ve paid your deductible).
Original Medicare does not provide an out-of-pocket limit.
Many Medicare Advantage plans support members by offering telehealth services, addressing behavioral health needs, connecting them to community resources, and managing care needs for improved whole-health.
What is a Special Needs Plan (SNP)?
A Medicare SNP, (pronounced like “snip”), is a Medicare Advantage coordinated care plan for people who have specific diseases, disabling conditions, certain healthcare needs, or who also have Medicaid.
There are three types of SNPs:
- Chronic Condition SNP (C-SNP).
- Dual Eligible SNP (D-SNP).
- Institutional SNP (I-SNP).
Chronic Condition SNP (C-SNP)
A C-SNP is designed to meet the needs of people with one or more severe or disabling chronic condition such as diabetes, end-stage renal (kidney) disease, or heart disease. The benefits, doctor and hospital networks, and prescription drugs are tailored to best meet the special needs of the member.
Dual Eligible SNP (D-SNP)
A D-SNP is for people who can have both Medicare and Medicaid and are therefore considered “dual eligible”. D-SNP members get standard Medicare benefits as well as additional coverages and services that meet their special needs.
Institutional SNP (I-SNP)
An I-SNP is for individuals who have had, or are expected to need, the level of services provided in a long-term care skilled nursing facility for 90 days or longer. It also has a model of preventive care to support healthy aging.
To learn more about Medicare, Medicare Advantage, and SNPs, including when to enroll, visit Medicare.gov .
