Plan Advisors Blog

Special Needs Plans: Avoid The Lock-in Lull

Posted by Lance Hoeltke on Mon, May 04, 2020 @ 01:17 PM

If you’re like most Medicare agents, you’ve likely found yourself in a lull when it’s not the annual election period from mid-October to early December. 

Special Needs Plans provide a steady market for brokers looking for additional opportunities year-round. Many seniors qualify for a Special Needs Plan, and here’s what you need to know to be ready to enroll them in the right plan. 

Understanding Coordinated Care Plans

There are multiple types of Medicare Advantage Plans that fall under a category called Coordinated Care Plans (CCPs). CCPs contract with a network of providers so that beneficiaries can typically expect to pay less out-of-pocket. 

There are 4 types of Coordinated Care Plans:

  1. Health Maintenance Organization (HMO)
  2. Preferred Provider Organization (PPO)
  3. Point of Service (POS)
  4. Special Needs Plans (SNP)

Of the four types of CCPs, Special Needs Plans (SNP) are not limited to an enrollment period, and individuals can enroll in an SNP at any time. If you're looking for opportunities to continue serving Medicare beneficiaries during lock-in, helping individuals who qualify for an SNP is a great way to do so. 

What You Need to Know About Special Needs Plans

Special Needs Plans (SNPs) are designed for people who have a qualifying special need. There are 3 different types of SNPs.

  1. Chronic Conditions Special Needs Plans (C-SNPs), for individuals who have been diagnosed with a severe chronic condition as defined by the Centers for Medicare & Medicaid Services. 
  2. Institutional Special Needs Plans (I-SNPs), for individuals who live in an institution, like a  nursing home or require home healthcare.
  3. Dual Eligible Special Needs Plans (D-SNPs), for individuals who are dual-eligible, meaning they qualify for both Medicare and Medicaid. 

Typically, each SNP limits its membership to a single group. For example, a C-SNP may only be open to people with chronic heart failure, so that it can specialize its network and benefits to provide the best care for the specific needs of that group.   

SNPs are a great option for your clients who qualify because all of their care is coordinated through the plan, and it’s specifically tailored to the needs of their condition. All SNPs are also required to include prescription drug coverage.

Added Benefits of SNPs for Your Clients

Some SNPs use care coordinators to help beneficiaries stay on track with their doctor’s treatment plan or navigate the best way to use their plan. You can think of care coordinators as a tour guide for your clients. They’ll help make sure they take the right route and do the right things to get the most out of their healthcare. 

The market for Special Needs Plans is probably larger than you think. Between the 3 types of SNPs, you have ample opportunities to continue selling throughout the lock-in period. Both becoming eligible and losing eligibility can result in Special Election Periods (SEPs) for your clients, so it’s important to check in with them periodically to make sure their status hasn’t changed.

Tags: Dual Eligibles, SNPs, D-SNP, Special Needs Plans