Dual Medicare Medicaid and Chronic Health Special Needs Plans in Florida

You can join a Medicare SNP if you meet these requirements:

• You have Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) .
• You live in the plan's service area
• You meet the plan's eligibility requirements for one of the 3 SNP types:

1. Chronic Condition SNP (C-SNP)-You have one or more of these severe or disabling chronic conditions:

• Chronic alcohol and other dependence
• Certain autoimmune disorders
• Cancer (excluding pre-cancer conditions)
• Certain cardiovascular disorders
• Chronic heart failure
• Dementia
• Diabetes mellitus
• End-stage liver disease
• End-stage Renal Disease (Esrd) requiring dialysis (any mode of dialysis)
• Certain severe hematologic disorders
• HIV/AIDS
• Certain chronic lung disorders
• Certain chronic and disabling mental health conditions
• Certain neurologic disorders
• Stroke

2. Institutional SNP (I-SNP) - You live You live in the community but need the level of care a facility offers, or if you live (or are expected to live) for at least 90 days straight in a facility like a:

• Nursing home
• Intermediate care facility
• Skilled nursing facility
• Rehabilitation hospital
• Long-term care hospital
• Swing-bed hospital
• Psychiatric hospital
• Other facility that offers similar long-term, health care services and whose residents have similar needs and health care status as residents of the facilities listed above

3. Dual Eligible SNP (D-SNP) - You’re eligible for both Medicare and Medicaid. D-SNPs contract with your state Medicaid program to help coordinate your Medicare and Medicaid benefits.

Each Medicare SNP limits its membership to people in one of these groups, or a subset of one of these groups.

For example, a Medicare SNP may be designed to serve only people diagnosed with congestive heart failure. The plan might include access to a network of providers who specialize in treating congestive heart failure. It would also feature clinical case management programs designed to serve the special needs of people with this condition. The plan's drug formulary would be designed to cover the drugs usually used to treat congestive heart failure. People who join this plan would get benefits specially tailored to their condition, and have all their care coordinated through the Medicare SNP.

A Formulary is a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Also called a drug list.

Each year, different types of Medicare SNPs may be available in different parts of the country. Insurance companies decide where they’ll do business, so Medicare SNPs may not be available in all parts of the country.

Insurance companies can decide that a plan will be available to everyone with Medicare in a state, or only in certain counties. Insurance companies may also offer more than one plan in an area, with different benefits and costs. Each year, insurance companies offering Medicare SNPs can decide to join or leave Medicare.

If you have Medicare and Medicaid, most of the costs of joining a Medicare SNP will be covered for you. Contact your Medicaid office for more information and to see if you qualify for Medicaid benefits.

If you don't have both Medicare and Medicaid (or get other help from your state paying your Medicare premiums), your exact costs will vary depending on the plan you choose. In general, you'll pay the basic costs of having a Medicare Advantage plan.

Medicare SNPs cover the same Medicare services that all Medicare Advantage plans must cover. Medicare SNPs may also cover extra services tailored to the special groups they serve, like extra days in the hospital. Contact your plan to learn exactly what benefits and services the plan covers.