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:
- SNP membership is restricted to people with specific diseases, income levels, or institutional needs.
- The average monthly premium for a Special Needs Plan in this area is $37.09.
- If you qualify for Medicaid, most copayments and other out-of-pocket costs will be covered for you. If not, your costs will be similar to traditional Medicare Advantage plans.
- All plans include a Medicare prescription drug plan (Part D). The average Part D deductible is $505.00.
- SNPs must cover the same services as Original Medicare.
- Each plan is tailored to provide the benefits, doctor choices, and prescription drug formularies needed to best serve its members.
- Medicare rated 67% of all SNPs in Mercer County 4 stars or higher.
NOTE: 2024 Medicare plan information will be available in early October. Sign-up for notification HERE.
Mercer County, Pennsylvania Medicare SNP Plans
|Plan Name||Type||Premium||Network||Part D
|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|
|Humana Gold Plus SNP-DE H6622-078||D-SNP||$34||HMO||$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|
Mercer County, PA
Medicare Advantage Special Needs Plan Information
Medicare Advantage Special Needs Plans (SNPs) are an alternative to Original Medicare. However, SNPs are not available to all Medicare beneficiaries in Mercer County. There are currently 16 SNPs available. Each plan is managed by a Medicare-approved private health plan following the strict rules and requirements set by Medicare.
To qualify as a person with special needs you must meet 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.
The Different Types of SNP Plans
There are three different types of Medicare Advantage Special Needs Plans:
- Dual-eligible SNPs (D-SNP) are for people who qualify for both Medicare and Medicaid.
- Institutional SNPs (I-SNP) are for beneficiaries who are institutionalized and live in long-term care or a skilled nursing facility.
- 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.
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:
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)
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:
- 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.
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
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.