While Pennsylvania Medicare Part D plans are the same throughout the state, the complexity of Medicare Special Needs Plans (SNPs) requires them to be localized. The primary reason for this is that each county has different healthcare providers, and the residents have different needs, so localized plans offer the best care. SNPs are similar to Medicare Advantage plans in Berks County, PA, but they have different enrollment requirements.
More Plan Options
The average Pennsylvania senior compares three or more plan options before making an enrollment decision.
Who Can Enroll in Medicare Special Needs Plan in Berks County?
SNP plans are not available to everyone. To join you must first prove have special needs based on one or more of the following criteria:
- An institutionalized individual,
- A dual-eligible (Medicare and Medicaid) person, or
- An individual with a severe or disabling chronic condition.
If you qualify, you can join or switch plans during a Medicare Election Period. For most people, the Annual Election Period (AEP), which starts on 15 October and ends 7 December, is the time they update their enrollment.
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 the month before and ends the month 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.
There are three ways to enroll in an SNP:
- Call our Trusted Partner at 1-855-266-4865. This toll-free number is staffed by HealthPlanOne, 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.