Special Needs Plans Offer Benefits to Those Who Have Unique Health Conditions

There is a special type of Medicare Advantage plan available to beneficiaries who have certain chronic conditions or who are also enrolled in Medicaid or who are living in a nursing home or other long-term care situation. A “Special Needs Plan” (SNP) is either an HMO or PPO plan type and covers the same Medicare Part A and Part B benefits that all Medicare Advantage Plans cover. But in addition, a SNP might also cover extra services for those with unique health needs. To be eligible, you must already have Medicare and live in a SNP service area (these service areas can vary year to year). You may qualify for a SNP if 1) you are “dual eligible,” meaning you have both Medicare and Medicaid coverage; or 2) you have a chronic condition such as cancer, heart failure, dementia, diabetes, end-stage kidney or liver disease, and others; or 3) you live for at least 90 days straight in a nursing home, skilled nursing facility, rehab hospital, or similar facility. Note that details such as possible surcharges, need for a referral, whether you must stay within a doctor/hospital network, etc., can vary from one SNP to another, so it is important to research and confirm all this to see if a SNP matches your situation and preferences. Comprehensive details can be found at https://www.medicare.gov/health-drug-plans/health-plans/your-coverage-options/SNP.

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Service Areas Details:

  • Boulder County and City of Boulder
  • Central Mountains: Chaffee, Custer, Fremont, Lake
  • City and County of Denver
  • City of Aurora
  • Colorado Springs Metro area: Counties of El Paso, Park, Teller
  • Denver Metro area: Counties of Adams, Arapahoe, Broomfield, Clear Creek, Denver, Douglas, Gilpin, Jefferson
  • Eastern Plains: Counties of Cheyenne, Elbert, Kit Carson, Lincoln
  • Larimer County and City of Fort Collins
    Las Animas/ Huerfano: Counties of Huerfano, Las Animas
  • Northeast Colorado: Counties of Logan, Morgan, Phillips, Sedgwick, Washington, Yuma
  • Northwest: Counties of Garfield, Mesa, Moffat, Rio Blanco, Routt
  • Pueblo County and City of Pueblo
  • San Juan Region: Counties of Archuleta, Dolores, La Plata, Montezuma, San Juan
  • South Central Colorado: Counties of Alamosa, Conejos, Costilla, Mineral, Rio Grande, Saguache
  • Southeast Colorado: Baca, Bent, Crowley, Kiowa, Prowers, Otero
  • Summit Region: Counties of Eagle, Grand, Jackson, Pitkin, Summit
  • Weld County
  • West Central: Counties of Delta, Gunnison, Hinsdale, Montrose, Ouray, San Miguel