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Overview of Medicare Advantage Special Needs Plan

Overview of Medicare Advantage Special Needs Plan

Medicare Special Needs Plans (SNPs) are offered by private companies to provide Medicare Part C to certain groups of people qualified for Medicare. The companies offering these plans must be approved by Medicare. All Medicare Special Needs Plans must also include Prescription Drug (Medicare Part D) coverage.

Special Need Plans are usually health maintenance organization (HMOs) or preferred provider organizations (PPOs). Enrollment in Special Needs Plans is limited to people with qualifying diseases and circumstances.

A Special Needs Plan covers virtually all the health care needs of its members. The idea is that these plans can tailor the benefits, health care provider choices, and list of prescription drugs to fit the special needs of people with a specific, serious disease or other circumstances.

According to Your Guide to Medicare Special Needs Programs , there are three types of Special Needs Plans.

  1. Chronic Disease Special Needs Plans

    These plans may be available to qualilfied individuals with serious and/or disabling health conditions. The list of diseases that may make you eligible for one of these plans includes:

    • Chronic alcohol and other drug dependence
    • Autoimmune disorders
    • Cancer (excluding pre-cancer conditions)
    • Cardiovascular disorders
    • Chronic heart failure
    • Dementia
    • Diabetes mellitus
    • End-stage liver disease
    • End-Stage Renal Disease (ESRD) requiring any mode of dialysis
    • Severe hematologic disorders
    • HIV/AIDS
    • Chronic lung disorders
    • Chronic and disabling mental health conditions
    • Neurologic disorders
    • Stroke
  2. Institutional Special Needs Plans
    • These plans may be available to eligible individuals who live in a nursing home or need a nurse to care for them in their home.
  3. Dual Eligible Special Needs Plans
    • These plans may be available to people who are eligible for both Medicare and Medicaid.

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Blue Cross Blue Shield Healthcare Plan of Georgia, Inc., is an HMO with a Medicare contract. Enrollment in Blue Cross Blue Shield Healthcare Plan of Georgia, Inc. depends on contract renewal.
Blue Cross and Blue Shield of Georgia, Inc. is an LPPO plan and a PDP plan with a Medicare contract. Enrollment in Blue Cross and Blue Shield of Georgia, Inc. depends on contract renewal.

Blue Cross and Blue Shield of Georgia, Inc., and Blue Cross Blue Shield Healthcare Plan of Georgia, Inc., are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

Anthem Insurance Companies Inc. (AICI) has contracted with the Centers for Medicare & Medicaid Services (CMS) to offer Medicare Prescription Drug Plans (PDPs) noted above or herein AICI is the state-licensed, risk-bearing entity offering these plans. AICI has retained the services of its related companies and authorized agents/brokers/producers to provide administrative services and/or to make the PDPs available in this region.

Blue Cross and Blue Shield of Georgia, Inc. and AICI are independent licensees of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.

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