It’s no secret medical care and treatment for those with intellectual disabilities is a large, ongoing expense, and many families are struggling to afford it. Medicare Advantage Plans have helped families shoulder this burden by providing prescription drug coverage and other benefits.
But there is a new Medicare Advantage Plan that might give families new hope. It’s called the Special Needs Plan (SNP). It provides greater access to providers and facilities, and offer dental, vision, and hearing benefits that are not part of Medicaid.
The Arc sent more information about SNPs to the community, and we’re sharing it below. If you need help in enrolling or have questions, call or e-mail Arc Advocacy Services 610-382-5805 or berksarc@aol.com.
Many service providers and advocates are unaware of the significant benefits to be derived from the Medicare Modernization Act, especially for individuals with Mental Retardation. While most people are familiar with Part D Prescription Drug coverage resulting from this legislation, few people are aware of the medical insurance benefits to be derived from Medicare Advantage for individuals who qualify for both Medicare and Medicaid.
The impetus behind the Medicare Modernization Act was to create competition in the Medicare marketplace. Part D continues to create more competition and lower costs for consumers. Medicare Advantage Plans are similarly encouraged by the Center for Medicare Services (CMS) to stimulate competition in the private sector and effectively lower insurance costs in the marketplace.
A new type of Medicare Advantage Plan is called the Special Needs Plan (SNP). Under current Medicaid law, eligible participants must seek care from a participating Medicaid provider in order to have Medicaid coverage that picks up what Medicare does not pay.
However, because of poor reimbursements and cumbersome claim filling requirements, most doctors and dentists are unwilling to participate in the state Medicaid program. As a result, many individuals have trouble seeing the doctors, dentists, and specialists that they would prefer to see. For many Medicaid recipients, their only access to healthcare is either through a clinic or through the emergency room.
The SNP attempts to correct this disparity in access to healthcare coverage by paying providers the full Medicare allowable charge or the negotiated insurance rate that the provider has agreed to! Provider participation with Medicaid is no longer a requirement, since Medicare Advantage is a Federal program! Several insurers in the five-county area and Berks County are offering provider access through their commercial insurance networks.
In addition to greater access to providers and facilities, these Special Needs Plans also offer dental, vision and hearing benefits that simply are not part of current Medicaid!
If you need help in enrolling or have questions, call or e-mail Arc Advocacy Services 610-382-5805 or berksarc@aol.com.
