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, including end-stage renal disease (ESRD), 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 four 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% of your costs for Medicare-approved services.

Part C is also known as a Medicare Advantage Plan. Part C is provided by plans like Keystone First VIP Choice (HMO SNP) that have been approved by the Centers for Medicare and Medicaid Services (CMS) and have contracts with Medicare 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 Keystone First VIP Choice 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 Keystone First VIP Choice, 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 Board payments. If you're receiving Social Security benefits or Railroad Retirement Board benefits, you'll receive information in the mail three months before your 65th birthday, explaining your options.

You are automatically enrolled in Medicare at the start of your 25th month if you become eligible for Medicare because of a disability and have been receiving Social Security Disability Insurance (SSDI) or railroad disability annuity checks for 24 months.

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 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 15 – December 7: 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.

Enroll now: Call us at 1-855-241-3648 (TTY 711) or enroll online.

Monday through Friday, 8 a.m. – 8 p.m., from April 1 to September 30; or seven days a week, 8 a.m. – 8 p.m., from October 1 to March 31.

Keystone First VIP Choice's Model of Care ( MOC) has been approved by the National Committee for Quality Assurance (NCQA) until December 31, 2021.