Seniorstar Insurance Group

Tag: Medicare Advantage

  • What Are Chronic Special Needs Plans?

    What Are Chronic Special Needs Plans?

    What Are Chronic Special Needs Plans?

    Chronic condition special needs plans, also called C-SNPS, are special types of Medicare Advantage plans that restrict enrollment to eligible members with specific chronic conditions. These plans include targeted care for these conditions such as diabetes, dementia, or heart disease and cover providers and care tailored to their unique needs. The drug formularies for these plans are also geared toward the needs of its eligible individuals.

    Like other Medicare Advantage plans, C-SNPs cover at least as much as Original Medicare Parts A & B, as well as C-SNPs, are required to include prescription drug coverage. This helps ensure eligible individuals can receive all their medical needs in one plan.

     C-SNPs may also assign a care coordinator that works with each beneficiary. Care coordinators help members access medications and healthcare providers that will best aid their care.

    Since they are tailored to a specific need of the condition, C-SNPs may have fewer coverage limitations than other Medicare Advantage (Part C) plans and may have lower or differing costs.

    Who Qualifies for a C-SNP?

    Almost 67% of Medicare enrollees have at least two chronic conditions that require care from primary providers, mental health specialists, inpatient and outpatient care, and ancillary services.

    Eligibility Requirements

    • Be eligible for Medicare
    • Live in the plan’s service area
    • Diagnosed with at least one qualifying chronic condition
      • Per the CDC, a condition is chronic if
        • It requires ongoing medical attention and/or limits the ability to perform daily living activities
        • It lasts one or more years

    What are the qualifying conditions?

    Fifteen specific chronic conditions are qualifying requirements for special needs plans. These may be periodically changed or revised depending on the care coordination through the SNP product.

    The 15 conditions that are C-SNP qualifying are as follows:

    • Chronic alcohol and other drug dependence
    • HIV/AIDS
    • Cancer, excluding pre-cancer conditions
    • Chronic heart failure
    • Diabetes Mellitus
    • Dementia
    • End-stage renal disease requiring dialysis
    • Stroke
    • Neurologic disorders limited to:
      • Amyotrophic lateral sclerosis (ALS)
      • Epilepsy
      • Extensive paralysis
      • Huntington’s disease
      • Multiple sclerosis
      • Parkinson’s disease
      • Polyneuropathy
      • Spinal stenosis
      • Stroke-related neurologic deficit
    • Chronic and disabling mental health conditions limited to:
      • Bipolar disorders
      • Major depressive disorders
      • Paranoid disorder
      • Schizophrenia
      • Schizoaffective disorder
    • Chronic lung disorders limited to:
      • Asthma
      • Chronic bronchitis
      • Emphysema
      • Pulmonary fibrosis
      • Pulmonary hypertension
    • Severe hematologic disorders limited to:
      • Aplastic anemia
      • Hemophilia
      • Immune thrombocytopenic purpura
      • Myelodysplastic syndrome
      • Sickle-cell disease (excluding sickle-cell trait)
    • Cardiovascular disorders limited to
      • Cardiac arrhythmias
      • Coronary artery disease
      • Peripheral vascular disease
      • Chronic venous thromboembolic disorder
    • Autoimmune disorders limited to
      • Polyarteritis nodosa
      • Polymyalgia rheumatica
      • Polymyositis
      • Rheumatoid arthritis
      • Systemic lupus erythematosus

    If you have questions about if you or a loved one may be eligible for a C-SNP, the team at Seniorstar can help! Give us a call today for no-cost coverage consultation.

  • Does My Doctor Accept Medicare?

    Does My Doctor Accept Medicare?

    Does My Doctor Accept Medicare?

    When you are enrolling in Medicare for the first time or changing your Medicare coverage, it is advisable to check and ensure that any providers you wish to continue seeing will still be covered. How do you find out if your doctor accepts your Medicare coverage? The answer is quite simple. However, it does depend on the type of Medicare coverage you are enrolled in.

    Are you enrolled in Original Medicare (with or without a Medicare Supplement)? If so, you will need to find out if your provider takes Original Medicare. Your Medicare Supplement will also cover any provider who takes Medicare. If you are enrolled in a Medicare Advantage plan, you will need to find out which providers are in your plan’s specific network.

    How Do I Know if My Doctor Accepts Original Medicare?

    Finding out if a doctor or provider takes Original Medicare is simple. You can visit medicare.gov and use their easy-to-use, free tool to find and compare providers and facilities that accept Original Medicare.

    Along with finding providers, you can also use this tool to compare providers and facilities with information including:

    • Cost estimates for doctors
    • Dialysis facilities and hospitals in your area
    • Contact information for local inpatient rehabilitation centers
    • Quality ratings for home health agencies and nursing homes

    You can also easily create a list of your favorite providers with this tool once you are logged in to Medicare.gov.

     How Do I Know if My Doctor Accepts My Medicare Advantage Plan?

    All Medicare Advantage plans, whether HMO, PPO, or SNP, will have a provider network. This process may be familiar to you if you have ever had job-based coverage through a spouse, parent, or partner.

    To find out which providers are in your plan’s network, you can go to your Medicare Advantage (Part C) plan’s website or contact your provider to request a provider directory. For some plans, you may need a referral from your primary care provider in order to have care from a specialist or specific hospital. It’s important to know that with some plans, choosing your primary care provider can also mean you are choosing a network of hospitals and specialists associated with them. These are all things to keep in mind when choosing a Medicare Advantage plan.

    At any time during the year, Medicare Advantage plans can add or remove providers from their network.

    If you have any questions, feel free to reach out to the team at Seniorstar Insurance Group at 732 658 5100.

  • The Medicare Annual Election Period (AEP) – Explained

    The Medicare Annual Election Period (AEP) – Explained

    The Medicare Annual Election Period (AEP) – Explained

    Commonly referred to as AEP, the Medicare Annual Election Period (AEP) is the time each year when you can change your Medicare coverage if you choose. The Medicare Annual Election Period (AEP) lasts from October 15 to December 7 every year, with plan changes going into effect on January 1 of the new year.

    Changes You Can Make to Your Coverage During AEP

    Depending on your coverage, you can make various changes during the Medicare Annual Election Period (AEP). Here are some tips based on the coverage you are currently enrolled in:

    I am Enrolled in…

    Original Medicare Parts A & B

    If you are currently enrolled in just Original Medicare Parts A & B, you can do the following during the Medicare Annual Election Period (AEP):

    • Join a Medicare Advantage (Part C) plan with built-in drug coverage.
    • Join a Medicare Advantage (Part C) plan without built-in drug coverage. Note: You may be charged a penalty if you do not have other creditable drug coverage
    • Join a stand-alone Medicare Part D Prescription Drug Plan. Note: You may also be charged a penalty if you are not currently enrolled in creditable drug coverage.

    You also have the option to make no changes; your coverage will remain as-is.

    Original Medicare Parts A & B with a Stand-Alone Medicare Part D Prescription Drug Plan

    Suppose you are enrolled in Original Medicare Parts A & B with a Stand-Alone Medicare Part D Prescription Drug Plan. In that case, you can do the following during the Medicare Annual Election Period (AEP):

    • Join a Medicare Advantage (Part C) plan with built-in drug coverage.
    • Join a Medicare Advantage (Part C) plan without built-in drug coverage.
    • Enroll in a new Medicare Part D Prescription Drug Plan and change your coverage from your existing plan
    • Drop Medicare Part D Prescription Drug coverage altogether. Note: If you decide to enroll in drug coverage in the future, you may be charged a penalty.

    You also have the option to make no changes; your coverage will remain as-is.

    Medicare Advantage (Part C) with a Stand-Alone Medicare Part D Prescription Drug Plan

    If you are enrolled in a Medicare Advantage (Part C) plan with a stand-alone Medicare Part D Prescription Drug Plan, you can do the following during the Medicare Annual Election Period (AEP):

    • Enroll in a different Medicare Advantage (Part C) plan with built-in drug coverage.
    • Enroll in a different Medicare Advantage (Part C) plan without built-in drug coverage.
    • Enroll in a new Medicare Part D Prescription Drug Plan and change your coverage from your existing plan
    • Drop Medicare Part D Prescription Drug coverage altogether. Note: If you decide to enroll in drug coverage in the future, you may be charged a penalty.
    • Leave your current Medicare Advantage (Part C) plan and return to Original Medicare.

    You also can make no changes, and your coverage will remain as-is.

    Medicare Advantage (Part C) with Built-in Drug Coverage

    If you are enrolled in a Medicare Advantage (Part C) plan with built-in drug coverage, you can do the following during the Medicare Annual Election Period (AEP):

    • Enroll in a different Medicare Advantage (Part C) plan with built-in drug coverage.
    • Enroll in a different Medicare Advantage (Part C) plan without built-in drug coverage.
    • Enroll in a stand-alone Medicare Part D Prescription Drug Plan if you enroll in a Medicare Advantage (Part C) plan that does not include drug coverage or if you go back to Original Medicare Parts A & B.
    • Drop Medicare Part D Prescription Drug coverage altogether. Note: If you decide to enroll in drug coverage in the future, you may be charged a penalty.
    • Leave your Medicare Advantage (Part C) plan and return to Original Medicare.

    You also have the option to make no changes; your coverage will remain as-is.

    Review Your Coverage with a Licensed Agent

    The Medicare Annual Election Period (AEP) is a great time to review your current coverage and ensure that you are enrolled in the Medicare coverage that meets your needs – medically and financially. At Seniorstar, we offer no-cost, no-obligation coverage reviews. We will help you evaluate your Medicare options, including Original Medicare Parts A & B, Medicare Advantage (Part C), Medicare Part D Prescription Drug Plans, and Medicare Supplements (Medigap).

    Click here to schedule an appointment, or call 732 658 5100