12 Special Needs Plans, Middlesex County, MA
We reviewed the top 12 Medicare Advantage Special Needs Plans (SNPs) available in Middlesex County, Massachusetts for 2023. 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 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 Middlesex County is $26.62 per month.
- If you are dual eligible (Medicare and MedicaidMedicaid 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 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). 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 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... drug plan. The average drug plan 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 per year.
- SNPs tailor plan benefits, provider choices, and drug formularies to meet the specific needs of the groups they serve.
- Medicare rated 27% of all SNPs in Middlesex County 4 stars or higher.
Middlesex County, Massachusetts Medicare SNP Plans
|Plan Name||Type||Premium||Network||Part D
|CCA Senior Care Options||D-SNP||$36||HMO||$505|
|UnitedHealthcare Senior Care Options||D-SNP||$21||HMO||$505|
|UnitedHealthcare Senior Care Options NHC||D-SNP||$18||HMO||$505|
|Senior Whole Health||D-SNP||$36||HMO||$505|
|Senior Whole Health NHC||D-SNP||$36||HMO||$505|
|Fallon Health NaviCare||D-SNP||$36||HMO||$505|
|Tufts Health Plan Senior Care Options||D-SNP||$36||HMO||$505|
|Tufts Health Plan Senior Care Options CW||D-SNP||$36||HMO||$505|
Middlesex County, MA
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 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.. However, not everyone with Medicare who lives in Middlesex County will qualify. As the name implies, the 12 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.
SNP plans are limited to those who qualify. To qualify as a special needs individual, you must meet one or more of three 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.
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 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... 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 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), and certain lung and heart disease.
Dual Eligible Special Needs Plans (D-SNPs) accept people who are eligible for both Medicare and Medicaid. Massachusetts 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 Middlesex County?
Even if you are one of the few Middlesex 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 Enroll in a Medicare Special Needs Plan in Middlesex 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, "Special Needs Plans (SNP)", Last Accessed June 20, 2022
- CMS.gov, "Institutional Special Needs Plans (I-SNPs)", Last Accessed April 19, 2022
- Medicare.gov, "Types of Medicare Advantage Plans", Last Accessed May 17, 2022
Our content follows the guidance provided by the Medicare Marketing Guidelines on CMS.gov. If you believe the information on this page is inaccurate, please contact us.