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What is a Medicare Advantage Special Needs Plan?

Medicare is a health insurance program run by the federal government. It is also known as original Medicare. It provides medical and health-related services to:

  • People age 65 and older.
  • People of any age who are qualified as disabled.
  • People of any age who have kidney disease that requires dialysis or a transplant.
  • People of any age who have Lou Gehrig's disease (also called amyotrophic lateral sclerosis [ALS]).

Medicare is made up of 4 parts: Part A, Part B, Part C, and Part D.

Part A is hospital coverage. It helps cover the costs of being in the hospital as an inpatient, as well as long-term hospitalization. Most people automatically get Part A at no monthly cost.

Part B is medical coverage. It helps cover your doctor visits and outpatient care as well as some preventive services that help maintain your health. Medicare Part B has a monthly premium. Once you meet a certain amount of spending, known as your deductible, Part B generally covers about 80 percent of your costs for Medicare-approved services.

Part C is also known as a Medicare Advantage plan. Part C is provided by plans like AmeriHealth Caritas VIP Care (HMO SNP) that have been approved by Medicare and have contracts with the Center for Medicare and Medicaid Services (CMS) to cover medical and hospitalization care for their members. They can also offer extra benefits that original Medicare doesn't cover such as hearing, dental, and vision services.

Part D is prescription drug coverage. Like Part C, it is also provided by private companies like AmeriHealth Caritas VIP Care that have a contract with CMS. It is designed to lower the amount that you pay for your prescription drugs. You can purchase a Part D plan to go with original Medicare, or prescription drug coverage may be included with a Medicare Advantage plan.

What are Medicare Special Needs Plans?

Medicare Special Needs plans (also known as SNPs) are Medicare Advantage plans that are designed for people who have special needs. A dual eligible SNP, like AmeriHealth Caritas VIP Care, is a Medicare Advantage plan specifically for people who are both Medicare and Medicaid beneficiaries.

How do I enroll in Medicare?

You are automatically enrolled in Medicare when you turn 65 if you receive Social Security or Railroad Retirement payments. If you're receiving Social Security benefits or Railroad Retirement Board benefits, you'll receive information in the mail 3 months before your 65th birthday, explaining your options.

If you are not yet receiving Social Security payments, then you will have to contact Social Security to enroll. You can call the Social Security Administration at 1-800-772-1213 (TTY/TDD 1-800-325-0778), visit the Social Security Administration website, or apply at your local Social Security office. It's a good idea to do this well before your birthday so you can start receiving benefits as soon as you're eligible.

When can I enroll in Medicare?

Medicare limits the times when most beneficiaries can add, change, or drop coverage (known as election or enrollment periods). Generally, beneficiaries who receive both Medicaid and Medicare can add, change, or drop coverage only once during each of the following:

  • January 1 – March 31
  • April 1 – June 30
  • July 1 – September 30
  • October 1 – December 31: You may request to add, change, or drop coverage, but the change won’t go into effect until January 1 of the following year.

What is a Health Maintenance Organization (HMO)?

An HMO is a type of health plan that uses a network of different health care providers — doctors, dentists, nurse practitioners, pharmacies, and hospitals — to treat members.

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