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 Special Needs Plans
A form of Medicare Advantage Plans, the Medicare Special Needs Plans are specially designed for people with certain chronic diseases and other specialized health needs. These plans must provide all Medicare Part A and Part B health care and services. Generally, they offer extra benefits and have lower co-payments or co-insurance amounts than the Original Medicare Plan.
Medicare Special Needs Plans are designed to meet the needs of people who:
- Live in certain institutions (like a nursing home)
- Are eligible for both Medicare and Medicaid, or
- Have one or more specific chronic or disabling conditions.
The plan may limit membership to people in one of these groups, but may enroll other people as well.
A Medicare Special Needs Plan may help manage and coordinate the many services and providers their members use to help them stay healthy, follow their doctor’s orders related to diet and prescription drugs, and help coordinate coverage between Medicare and Medicaid. They may also identify a care coordinator to develop personal care plans to coordinate all health care provider efforts to meet the patient’s needs. For example, a Medicare Special Needs Plan for people with diabetes might use a care coordinator to help members monitor blood sugar, follow their diet, get proper exercise, get needed preventive services such as eye and foot exams, and get the right medicines to prevent complications.
A Medicare Special Needs Plan for people with both Medicare and Medicaid might help members access community resources and coordinate many of their Medicare and Medicaid services, as well as offer extra benefits not available with either Medicare or Medicaid.
Your Medicare decisions are important because they affect things like how much you pay and what is covered. Before making any decisions, learn as much as you can about the types of plans and coverage available to you. Work with someone who is experienced in the Medicare market and is certified to discuss the Advantage plan(s) you are considering, and understands the special needs plans. It is one of the best ways to get the information you need.
At OFM, we have the experience, knowledge and certification(s). OFM has pioneered the offerings of special needs plans in both Kansas and Missouri. We have helped those seniors with dual (Medicare & Medicaid) eligibility, and special health issues, find plans that will work well for them, and benefits previously not available to them. Let us help you make the right decisions about your Medicare Special Needs coverage.
To receive a quote on any of our Special Needs Plans, click here.
If you would like to speak to an OFM Benefits Consulting representative about Medicare Special Needs Plans, click here or call 888-293-7923. |
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