SNPs: The Secret to Surviving Lock-in

Strategizing your sales during Medicare lock-in is a surefire way to carry your business through the health insurance doldrums.

It’s what can set your business apart from a seasonally profitable to an annually profitable endeavor. But how do you continue to grow outside of AEP? You get contracted for a Special Needs Plan.

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What is an SNP?

Special Needs Plans (SNPs) function like a Medicare Advantage HMO or PPO plan, but are specialized even more to their members’ needs. For this reason, enrollment is limited to people with certain diseases or characteristics.

How do you continue to grow outside of AEP? You get contracted for a Special Needs Plan.

While these plans won’t work for every client, they are valuable for agents trying to do business outside of AEP. How you ask? Many SNPs have Special Enrollment Periods (SEPs) that let your eligible clients join at any time, not just during AEP. Let’s take a look at the framework of SNPs, the types of plans, and when your clients can enroll.

How do they work?

Special Needs Plans are private plans that, by law, must cover all medically necessary and preventative services that would be covered under Original Medicare. It must also provide prescription drug coverage that would normally be covered under Part D.

Each SNP offers their members specialized benefits and services based on their group. These groups can be either specific provider networks or formularies. For example, a C-SNP might have a more comprehensive list of drugs on the formulary since it’s designed for members with chronic conditions. It’s important to research each plan to see what exactly is covered and how that fits your client’s needs.

It’s important to note that if your clients have a Medicare Supplement plan, they can remain enrolled in that plan while enrolled in a Medicare SNP, however, it may be costly! The client will receive little benefit from the Medicare Supplement since it won’t cover any out-of-pocket costs of the SNP, but they may want to keep the plan until they’re confident they’re happy with their SNP.

Who is eligible?

There are three different types of SNPs to serve different needs: Chronic Condition Special Needs Plans (C-SNPs), Dual-Eligible Special Needs Plans (D-SNPs), and Institutional Special Needs Plans (I-SNPs). The eligibility requirements are in line with the care that beneficiaries require:

C-SNPs

C-SNPs cover those with chronic conditions on Medicare, and the coverage is tailored to their specific illness. Qualifying conditions include: chronic alcohol and other drug dependence, autoimmune disorders, cancer, cardiovascular disorder, chronic heart failure, dementia, diabetes mellitus, end-stage liver disease, end-stage renal disease (ESRD), severe hematologic disorders, HIV/AIDS, chronic lung disorder, chronic and disabling mental health conditions, neurologic disorders, and stroke. Some C-SNPs accept people who have ESRD even though standard Medicare Advantage plans exclude this.

D-SNPs

Dual-Eligible SNPs are your most common lock-in sales. To enroll in a D-SNP, a client must qualify for both Medicaid and Medicare. If they do, most of their medical costs will be covered by the plan.

I-SNPs

Last in our alphabet soup are Institutional SNPs, which cover people who are living in an institution or require home nursing care.

Most importantly, when can they join?

Normal enrollment for a C-SNP occurs during an Initial Election Period (IEP) or the Annual Enrollment Period (AEP), but a client can get an SEP if they have a doctor’s documentation of a newly-acquired chronic condition. With I-SNPs, beneficiaries can join a plan upon becoming eligible for one and can switch I-SNPs once every month (as long as they remain eligible for this type of plan).

D-SNPs also allow beneficiaries to join a plan upon becoming eligible for one. This SEP lasts for three months after their change in dual-eligible status or their notification of the change — whichever is later. Additionally, there is an SEP that allows beneficiaries to join or switch D-SNPs once during each of the first three calendar quarters of the year (as long as they remain eligible for this type of plan), which makes them very valuable during lock-in.

While these plans won’t work for every client, they are valuable for agents trying to do business outside of AEP.

Additionally, if a client moves out of their SNP’s service area or if the SNP leaves the Medicare program, any member of that plan will have an SEP to enroll in another plan.

The secret’s out, now use it

As you’re pursuing leads during lock-in, you should consider Medicare Special Needs Plans for clients who fall into one of the three categories: Chronic, Institutional or Dual Eligible. Make sure to research each individual plan to see the different benefits and services that are available in order to choose the best possible option for your client.

SNPs will keep your business thriving when other agents’ sales hit a lull. When you look at your annual growth, you’ll see the benefits of adding SNP sales to your business formula.