Medicare Special Needs Plans Ada County, Idaho
We reviewed the top 5 Medicare Advantage Special Needs Plans (SNPs) available in Ada County, Idaho. This is what we learned:
- Special Needs Plans are not available to everyone. Membership is limited to people with specific diseases or characteristics.
- The average A 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 Ada County is $42.90 per month.
- If you are dual eligible (Medicare and Medicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States.), most of your healthcare costs are fully covered.
- SNPs cover the same services that all Medicare 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). must cover.
- SNPs may also cover extra services tailored to the special groups they serve, like extra days in the hospital.
- All SNPs include a Medicare 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... drug plan. The average drug plan A deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share. is $480.00 per year.
- SNPs tailor plan benefits, provider choices, and drug formularies to meet the specific needs of the groups they serve.
- Medicare rated 40% of all SNPs in Ada County 4 stars or higher.
Ada County, Idaho Medicare SNP Plans
|Plan Name||Type||Premium||Network||Part D
|American Health Advantage of Idaho||I-SNP||$43||HMO||$480|
|Molina Medicare Complete Care||D-SNP||$43||HMO||$480|
|Molina Medicare Complete Care Select||D-SNP||$43||HMO||$480|
|True Blue Special Needs Plan||D-SNP||$43||HMO||$480|
|True Blue Special Needs Plan||D-SNP||$43||HMO||$480|
Ada County, ID
Medicare Advantage Special Needs Plan Information
Special Needs Plans (SNPs), which are part of the Medicare Advantage program, are a private health plan alternative to Original 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.. However, not everyone with Medicare who lives in Ada County will qualify. As the name implies, the 5 SNPs available are for people with special needs. Each plan is facilitated by Medicare-approved private companies that agree to provide coverage by Medicare's rules. All plans offer additional benefits that aren’t available through Original Medicare.
To join a SNP you must first prove you have special needs based on one or more of the following three criteria:
- An institutionalized individual,
- A Dual-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.
There are Different Types of Special Needs Plans
Not all Medicare Special Needs Plans are the same. There are three different type:
- Dual-eligible Special Needs Plans (D-SNP) are for beneficiaries with both Medicare and Medicaid benefits.
- Institutional Special Needs Plans (I-SNP) serve people staying in a a 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... facility or a skilled nursing facility.
- Chronic Condition Special Needs Plans (C-SNP) provide coordinated care Medicare beneficiaries with one or more serious diseases, including diabetes, End-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), and certain lung and heart disease.
Dual Eligible Special Needs Plans (D-SNPs) accept people who are eligible for both Medicare and Medicaid. Idaho covers some Medicare costs, depending on the beneficiary’s eligibility. Medicaid eligibility categories include:
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.
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
- Diabetes mellitus
- End-stage liver disease
- End-stage renal disease (ESRD) requiring dialysis
- Severe hematologic disorders (limited)
- Chronic lung disorders (limited)
- Chronic and disabling mental health conditions (limited)
- Neurologic disorders (limited)
When Can I Get a Special Needs Plan in Ada County?
Even if you are one of the few Ada County residents who qualify, you are only allowed to join, drop or change plans during a Medicare Election Period. The period between 15 October and 7 December is the Annual Election Period (AEP). That's when most folks make changes to their Medicare.
You also have an Individual Election Period (IEP). Your IEP begins three months before your 65th birthday, includes your birth month, and continues for three months after your birth month.
Outside of these periods, you may be able to join a Special Needs Plan with a Special Election Period. Some situations that may qualify you for a Special Election Period include:
- 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.
How to Get Enrolled in a Medicare SNP in Ada 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, 2022 SNP Landscape Source Files, Last Accessed October 26, 2021
- Medicare.gov, "Special Needs Plans (SNP)", Last Accessed June 20, 2022
- CMS.gov, "Institutional Special Needs Plans (I-SNPs)", Last Accessed April 19, 2022
- MedicareWire.com, "What is Medicare Advantage?", Last Accessed August, 2021
The 2023 Medicare Special Needs Plans in Idaho information on this page was last updated on .