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16 Special Needs Plans, Allegheny County, PA

by , last updated

We reviewed the top 16 Medicare Advantage Special Needs Plans (SNPs) available in Allegheny County, Pennsylvania for 2023 (2024 plans will be available in early October. Sign-up for notification HERE). This is what we learned:

Key Facts

  1. Special Needs Plans are not available to everyone. Membership is limited to people with specific diseases or characteristics.
  2. The average premium for a Special Needs Plan in Allegheny County is $37.00 per month.
  3. If you are dual eligible (Medicare and Medicaid), most of your healthcare costs are fully covered.
  4. SNPs cover the same services that all Medicare Advantage plans must cover.
  5. SNPs may also cover extra services tailored to the special groups they serve, like extra days in the hospital.
  6. All SNPs include a Medicare Part D drug plan. The average drug plan deductible is $505.00 per year.
  7. SNPs tailor plan benefits, provider choices, and drug formularies to meet the specific needs of the groups they serve.
  8. Medicare rated 67% of all SNPs in Allegheny County 4 stars or higher.

NOTE: 2024 Medicare plan information will be available in early October. Sign-up for notification HERE.

Allegheny County, Pennsylvania Medicare SNP Plans

Medicare Special Needs Plans in Allegheny County, PA for 2023
Plan Name Type Premium Network Part D
Deduct.		 Rating
UnitedHealthcare Nursing Home Plan 2 I-SNP $41 PPO $505
☆☆☆☆☆
Aetna Medicare Advantra Cares D-SNP $25 HMO $505
☆☆☆☆☆
Aetna Medicare Longevity Plan I-SNP $41 HMO $505
☆☆☆☆☆
HumanaChoice SNP-DE H5216-227 D-SNP $33 PPO $505
☆☆☆☆☆
UPMC for Life Complete Care D-SNP $41 HMO $505
☆☆☆☆☆
Highmark Wholecare Medicare Assured Diamond D-SNP $41 HMO $505
☆☆☆☆☆
Highmark Wholecare Medicare Assured Ruby D-SNP $41 HMO $505
☆☆☆☆☆
UnitedHealthcare Dual Complete D-SNP $34 HMO-POS $505
☆☆☆☆☆
UnitedHealthcare Dual Complete Choice D-SNP $41 PPO $505
☆☆☆☆☆
UnitedHealthcare Dual Complete Select D-SNP $38 HMO-POS $505
☆☆☆☆☆
AmeriHealth Caritas VIP Care D-SNP $41 HMO $505
☆☆☆☆☆
Cigna TotalCare Plus D-SNP $25 HMO $505
☆☆☆☆☆
Wellcare Dual Access D-SNP $31 HMO $505
☆☆☆☆☆
Provider Partners Pennsylvania Advantage Plan I-SNP $41 HMO $505
☆☆☆☆☆
Provider Partners Pennsylvania Community Plan I-SNP $41 HMO $505
☆☆☆☆☆

Allegheny County, PA
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. However, not everyone with Medicare who lives in Allegheny County will qualify. As the name implies, the 16 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:

  1. An institutionalized individual,
  2. A dual-eligible (Medicare and Medicaid) person, or
  3. An individual with a severe or disabling chronic condition.

If you qualify for Medicare in Allegheny County but don't know where to begin, we have licensed insurance agents[1] at 1-855-728-0510 (TTY 711) who can answer your questions (Mon-Fri, 8am-9pm , Sat 8am-8pm EST) and help you get enrolled. There's no obligation.

There are Different Types of Special Needs Plans

Not all Medicare Special Needs Plans are the same. There are three different type:

  1. Dual-eligible Special Needs Plans (D-SNP) are for beneficiaries with both Medicare and Medicaid benefits.
  2. Institutional Special Needs Plans (I-SNP) serve people staying in a long-term care facility or a skilled nursing facility.
  3. 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), and certain lung and heart disease.

D-SNP

Dual Eligible Special Needs Plans (D-SNPs) accept people who are eligible for both Medicare and Medicaid. Pennsylvania covers some Medicare costs, depending on the beneficiary’s eligibility. Medicaid eligibility categories include:

  • Full Medicaid (only);
  • Qualified Medicare Beneficiary without other Medicaid (QMB Only);
  • QMB Plus;
  • Specified Low-Income Medicare Beneficiary without other Medicaid (SLMB Only);
  • SLMB Plus;
  • Qualifying Individual (QI); and
  • Qualified Disabled and Working Individual (QDWI).

    • All D-SNPs must identify whether the plan offers Medicare zero-dollar cost sharing.

    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::

    1. Chronic alcohol and other drug dependence
    2. Autoimmune disorders (limited)
    3. Cancer, excluding pre-cancer conditions or in-situ status
    4. Cardiovascular disorders (limited)
    5. Chronic heart failure
    6. Dementia
    7. Diabetes mellitus
    8. End-stage liver disease
    9. End-stage renal disease (ESRD) requiring dialysis
    10. Severe hematologic disorders (limited)
    11. HIV/AIDS
    12. Chronic lung disorders (limited)
    13. Chronic and disabling mental health conditions (limited)
    14. Neurologic disorders (limited)
    15. Stroke

    When Can I Get a Special Needs Plan in Allegheny County?

    Even if you are one of the few Allegheny 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.
    Are you ready to enroll? Do you still have questions? Our licensed insurance agents are ready to help with no obligation. Call 1-855-728-0510 (TTY 711) for assistance Mon-Fri, 8am-9pm , Sat 8am-8pm EST.

    How to Enroll in a Medicare Special Needs Plan in Allegheny County

    There are three ways to enroll in an SNP:

    1. 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.
    2. 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.
    3. 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.

    Plans Offered

    Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Centene Corporation, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna-HealthSpring, Humana, Molina Healthcare, Mutual of Omaha, Oscar Health Insurance, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, and UnitedHealthcare.

    Citations & References

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