5 Special Needs Plans, La Paz County, AZ
We reviewed the top 5 Medicare Advantage Special Needs Plans (SNPs) available in La Paz County, Arizona for 2023. This is what we learned:
Key Facts
- SNP membership is restricted to people with specific diseases, income levels, or institutional needs.
- The average monthly premiumA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. for a Special Needs Plan in this area is $38.92.
- If you qualify for MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States., most copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service. and other out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. will be covered for you. If not, your costs will be similar to traditional MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage.Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B)..
- All plans include a Medicare prescription drug plan (Part DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each...). The average Part D deductibleA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share. is $505.00.
- SNPs must cover the same services as Original Medicare.
- Each plan is tailored to provide the benefits, doctor choices, and prescription drug formularies needed to best serve its members.
- Medicare rated 20% of all SNPs in La Paz County 4 stars or higher.
La Paz County, Arizona Medicare SNP Plans
| Plan Name | Type | Premium | Network | Part D Deduct. |
Rating |
|---|---|---|---|---|---|
| UnitedHealthcare Dual Complete LP | D-SNP | $43 | HMO-POS | $505 | |
| Wellcare Dual Liberty | D-SNP | $25 | HMO | $505 | |
| Banner Medicare Advantage Dual | D-SNP | $42 | HMO | $505 | |
| Banner Medicare Advantage Dual | D-SNP | $43 | HMO | $505 | |
| Mercy Care Advantage | D-SNP | $43 | HMO | $505 |
La Paz County, AZ
Medicare Advantage Special Needs Plan Information
Medicare Advantage Special Needs Plans (SNPs) are an alternative to Original Medicare. However, SNPs are not available to all Medicare beneficiaries in La Paz County. There are currently 5 SNPs available. Each plan is managed by a Medicare-approved private health plan following the strict rules and requirements set by Medicare.
To qualify as a person with special needs you must meet one or more of the following criteria:
- An institutionalized individual,
- A dual-eligibleDual-eligible beneficiaries are those who receive both Medicare and Medicaid benefits. It includes beneficiaries enrolled in Medicare Part A and/or Part B while receiving full Medicaid and/or financial assistance through a Medicare Savings Program.... (Medicare and Medicaid) person, or
- An individual with a severe or disabling chronic condition.
The Different Types of SNP Plans
There are three different types of Medicare Advantage Special Needs Plans:
- Dual-eligible SNPs (D-SNP) are for people who qualify for both Medicare and Medicaid.
- Institutional SNPs (I-SNP) are for beneficiaries who are institutionalized and live in long-term carea variety of services that help people with their medical and non-medical needs over a period of time. Long-term care can be provided at home, in the community, or in various types of facilities, including... or a skilled nursing facility.
- Chronic Condition SNPs (C-SNP) are for people with one or more chronic conditions, including diabetes, end-stage renal diseaseEnd-Stage Renal Disease (ESRD), also known as kidney failure, is a condition that causes you to need dialysis or a kidney transplant. People with ESRD are eligible for Medicare coverage regardless of age. (ESRD), lung conditions or heart disease.
D-SNP
Dual Eligible Special Needs Plans (D-SNPs) accept people who are eligible for both Medicare and Medicaid. Arizona covers some Medicare costs, depending on the beneficiary’s eligibility. Medicaid eligibility categories include:
I-SNP
Institutional Special Needs Plans (I-SNPs) are SNPs that restrict enrollment to Medicare beneficiaries who, for 90 days or longer, have had or are expected to need the level of services provided in a long-term care facility, skilled nursing facility, an intermediate care facility for individuals with intellectual disabilities, or an inpatient psychiatric facility.
Prior to enrolling in a I-SNP, beneficiaries are advised to verify their institution accepts the plan and that its healthcare providers are in the plan's provider network.
C-SNP
Chronic Condition SNPs restrict enrollment to special needs individuals with severe or disabling chronic conditions. About two-thirds of Medicare enrollees have multiple chronic conditions requiring coordination of care among primary care providers, medical and mental health specialists, inpatient and outpatient facilities, and extensive ancillary services related to diagnostic testing and therapeutic management.
There are 15 SNP-specific chronic conditions::
- Chronic alcohol and other drug dependence
- Autoimmune disorders (limited)
- Cancer, excluding pre-cancer conditions or in-situ status
- Cardiovascular disorders (limited)
- Chronic heart failure
- Dementia
- Diabetes mellitus
- End-stage liver disease
- End-stage renal disease (ESRD) requiring dialysis
- Severe hematologic disorders (limited)
- HIV/AIDS
- Chronic lung disorders (limited)
- Chronic and disabling mental health conditions (limited)
- Neurologic disorders (limited)
- Stroke
Medicare SNP Enrollment Periods
For those La Paz County residents who qualify, there are several different Medicare Election Periods. This is when you can join or change your plan. Most people wait until 15 October to 7 December to make enrollment changes. This is the Annual Election Period (AEP).
Most of us also get an Individual Election Period (IEP), but it only comes around once. Your IEP is based on your 65th birthday. It starts three months before your birth month and ends three months after, so you have plenty of time.
You may also qualify for a Special Election Period in certain situations, including:
- You are diagnosed with a severe or disabling condition: You can enroll in a Chronic-Condition Special Needs Plan (C-SNP) for beneficiaries with your illness at any time.
- You move into a nursing home or require skilled nursing care at home: You can enroll in an Institution Special Needs Plan (I-SNP) or switch plans at any time.
- You qualify for Medicaid: If you have Medicaid or are newly eligible for Medicaid, you can enroll in a Dual-Eligible Medicare Special Needs Plan (D-SNP) at any time.
- You move outside of your existing Special Needs Plan’s service area: You'll qualify for a Special Election Period to switch to a new plan.
- Your Special Needs Plan leaves the Medicare program: You'll qualify for a Special Election Period to switch plans.
Getting Enrolled in a Special Needs Plan in La Paz County
There are three ways to enroll in an SNP:
- Call our Trusted Partner at 1-855-728-0510 (TTY 711). This toll-free number is staffed by HealthCompare, the outsourced partner of choice for some of the nation’s largest health plans.
- Call a plan directly. If you know the plan you want, this way is quick and easy. All of our plan pages provide contact information.
- Go to www.Medicare.gov and enroll through the government website. From there you can look up your medications, compare plans, and get your application started online.
Citations & References
- CMS.gov, 2023 SNP Landscape Source Files, Last Accessed January 13, 2023
- Medicare.gov, "How Medicare Special Needs Plans (SNPs) work", Last Accessed May 11, 2022
- CMS.gov, "Dual Eligible Special Needs Plans (D-SNPs)", Last Accessed April 3, 2022
- Medicare.gov, "Understanding Medicare", Last Accessed June 18, 2022
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