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Medicare Special Needs Plans
The following types of health plans are also Medicare Advantage Plans. They are available in some areas to people who meet certain conditions.
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. They also must provide Medicare prescription drug coverage (Part D). Generally, they offer extra benefits and may have lower Copayments 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) or who continue to live at home, but require the same care as someone living in 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.
Visit www.medicare.gov on the web to get help learning about and comparing Medicare Special Needs Plans in your area. Select "Compare Health Plans and Medigap Policies in Your Area." Or, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048.
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(Primary Source: Centers for Medicare and Medicaid Services - Medicare and You Handbook 2007. This content may have been added upon by Q1Group LLC to include further examples, explanations, and links.)
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Last updated on: 07/18/2008
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