16 Special Needs Plans, Mercer County, PA

by David Bynon, last updated August 17, 2023

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

Mercer County, PA
Medicare Advantage Special Needs Plan Information

The Different Types of SNP Plans

There are three different types of Medicare Advantage Special Needs Plans:

1. Dual-eligible SNPs (D-SNP) are for people who qualify for both Medicare and Medicaid.
2. Institutional SNPs (I-SNP) are for beneficiaries who are institutionalized and live in long-term care or a skilled nursing facility.
3. Chronic Condition SNPs (C-SNP) are for people with one or more chronic conditions, including diabetes, end-stage renal disease (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. 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

Medicare SNP Enrollment Periods

For those Mercer 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 Mercer 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

• 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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