Understanding the Humana Special Needs Plan

Written By: Nathan Justice
Reviewed By: William Rivers
Published: October 6, 2023
Last updated: October 9, 2023

Are you a Medicare beneficiary with complex medical needs? Do you find it challenging to navigate through the various Medicare plans available? While standard healthcare plans offer a broad spectrum of benefits, there are those among us with distinct needs that demand specialized attention. This is where the Humana Special Needs Plan (SNP) comes into play.

The Humana Special Needs Plan is crafted to provide additional healthcare support. By gaining a better understanding of the Humana SNP, you can make an informed decision about your healthcare coverage and ensure that your specific needs are met. In this guide, we'll delve into the key aspects of this plan, including its benefits, eligibility criteria, and how it can provide a higher level of care for Medicare beneficiaries with complex medical needs. 

What is the Humana Special Needs Plan? 

If you or someone you know has a chronic illness or is living with a disability, you may be familiar with the challenges of navigating the healthcare system. Fortunately, there are specialized healthcare plans available to cater to the unique needs of individuals in these situations. One such plan is the Humana Special Needs Plan (SNP), which offers comprehensive care and support for those with specific health conditions.

So, what exactly is the Humana Special Needs Plan? Let's delve into the details.

Just like the Humana Healthy Food Card initiative, the Humana Special Needs Plan is a Medicare Advantage plan designed for individuals who meet certain criteria. This plan works in conjunction with Original Medicare to provide additional benefits and tailored care for individuals with chronic conditions, disabilities, or other specific healthcare needs.

3 Categories of Humana Special Needs Plans 

At its core, the Humana SNP goes beyond standard healthcare provisions, focusing on individuals who face specific challenges that standard plans might not adequately address. The SNP is available in different variations, each catering to a specific group of people. There are three main categories of Humana Special Needs Plans.

1. Chronic Condition SNP (C-SNP)

This plan is designed for individuals living with chronic conditions such as diabetes, cardiovascular disease, or chronic lung disorders. It offers specialized services, medication coverage, and disease management programs to help individuals effectively manage their condition while receiving comprehensive healthcare.

Here’s a closer look at the key highlights of this program:

  • Tailored Benefits: The plan's benefits, drug formulary, and provider choices are tailored to meet the specific needs of the groups they serve. For instance, a C-SNP for individuals with diabetes might offer additional diabetic education, enhanced foot care benefits, and a specialized formulary designed for managing diabetes.

  • Specialized Provider Networks: C-SNPs often include a network of providers, including Humana, that specialize in treating the specific chronic conditions the SNP is designed for.

  • Care Management: These plans provide enhanced care management to ensure that members receive the necessary care and support to manage their chronic condition.

  • Eligibility: To be eligible for a C-SNP, a beneficiary must have one or more of the specific chronic conditions that the plan covers. The list of chronic conditions for C-SNPs can change, but as of my last update, it includes conditions like chronic alcohol or other drug dependence, chronic heart failure, diabetes, end-stage liver disease, HIV/AIDS, and others.

  • Enrollment Periods: Beneficiaries can enroll in a C-SNP during their initial enrollment period when they first become eligible for Medicare under Humana, during the Annual Election Period (AEP), or during a Special Election Period (SEP) if they qualify.

C-SNPs may not be available in all states or regions. Availability depends on whether the plan chooses to offer its services in a specific area and if it's approved by Medicare to do so.

2. Dual Eligible SNP (D-SNP)

This plan is for individuals who are eligible for both Medicare and Medicaid. It provides enhanced benefits and coordination of care, including prescription drug coverage, dental and vision services, and transportation assistance.

The goal of this plan is to provide a seamless healthcare experience for enrollees, merging the benefits of both Medicare and Medicaid into a single plan. Let’s take a closer look at what this Humana Special Needs Plan entails:

  • Integrated Care: One of the main advantages of Humana's D-SNP is the integration of services between Medicare and Medicaid. This can result in better coordination of care, more comprehensive coverage, and fewer administrative hassles for beneficiaries.

  • Prescription Drug Coverage: Most of Humana's D-SNPs include prescription drug coverage, which means beneficiaries don't need a separate Part D plan.

  • Additional Benefits: Depending on the state and the specific plan, Humana's D-SNPs may offer additional benefits beyond traditional Medicare, such as vision, and hearing coverage, over-the-counter allowances, wellness programs, and dental coverage under Humana.

  • Care Coordination: Humana D-SNPs often offer care coordination or case management services to ensure beneficiaries get the right care at the right time, especially if they have complex health needs.

Due to the combined assistance of Medicare and Medicaid, many beneficiaries may find that they have low or even no monthly premiums, reduced out-of-pocket costs, and minimal copays for certain services.

To be eligible for a Humana D-SNP, an individual must be enrolled in both Medicare Part A and Part B and receive full Medicaid benefits. The exact criteria for Medicaid eligibility can vary by state.

3. Institutional SNP (I-SNP)

This plan is tailored for individuals residing in long-term care facilities, such as nursing homes or assisted living facilities. It ensures that the unique healthcare needs of these individuals are met, including coverage for medical services, prescription drugs, and assistance with activities of daily living.

The primary goal is to provide these individuals with healthcare services that are specifically designed to meet their unique needs and ensure continuous, specialized care.

  • Customized Care: I-SNPs are specifically designed to meet the health needs of institutionalized individuals or those requiring similar care. This often includes services tailored to chronic illness management, specialized therapies, and continuous care needs.

  • Care CoordinationBeneficiaries of I-SNPs typically receive enhanced care coordination to ensure that they get timely access to the required services and that there's smooth communication between various healthcare providers.

  • Provider Networks: I-SNPs may have networks that include providers specialized in treating individuals in long-term care settings or those with conditions commonly found in such populations.

  • Comprehensive Coverage: Most I-SNPs offer prescription drug coverage (Part D), meaning beneficiaries do not need a separate Part D plan. In addition, many I-SNPs offer extra benefits beyond traditional Medicare, such as vision, dental, and hearing coverage, depending on the specific plan and location.

To be eligible for an I-SNP, an individual typically needs to be:

  • Living in an institution, such as a nursing home, for 90 days or longer, or

  • Living at home but requiring an institutional level of care.

Beneficiaries can enroll in an I-SNP during their initial enrollment period when they first become eligible for Medicare. They can also make changes during the Annual Election Period or during certain Special Election Periods if they qualify. If someone’s health needs change and they no longer meet the criteria for an I-SNP, they might need to choose another Medicare plan that better suits their current circumstances.

How to Enroll For Humana Special Needs Plan

Enrolling in a Humana Special Needs Plan can provide you with specialized healthcare coverage tailored to your specific needs.  If you're interested in enrolling in a Humana SNP, here are some steps to guide you through the process:

Step 1: Determine Eligibility

Before enrolling in a Humana SNP, it's important to ensure that you meet the eligibility criteria. Special Needs Plans are designed for individuals with specific conditions or circumstances, such as chronic illnesses, dual eligibility for Medicare and Medicaid, or residing in a long-term care facility. 

Step 2: Research Available Plans

Humana offers a variety of Special Needs Plans catered to different healthcare needs. Take the time to research and compare the available plans to find the one that best suits your requirements. Consider factors such as coverage, benefits, prescription drug options, and network of providers. 

Step 3: Contact Humana

Once you have identified the Humana SNP that aligns with your needs, it's time to get in touch with Humana. You can reach out to them through their website or call their customer service helpline. A representative will guide you through the enrollment process.

Step 4: Gather Necessary Information

Before enrolling in a Humana SNP, you'll need to have certain information on hand. This includes your personal details, such as your name, date of birth, and contact information. You should also have your Medicare and/or Medicaid information readily available, as well as any information related to your specific health condition or special healthcare needs.

Step 5: Complete the Enrollment Application

Humana will provide you with an enrollment application that needs to be filled out accurately and completely. Make sure to review the application thoroughly and provide all the requested information. If you have any doubts or concerns, don't hesitate to ask the Humana representative for clarification.

Step 6: Submit the Application

Once you have completed the enrollment application, it's time to submit it to Humana. They will review your application and determine your eligibility for the chosen Special Needs Plan. It's important to submit your application well before any enrollment deadlines to ensure a smooth transition into the plan.

Step 7: Review Your Plan Details

After your application has been processed and approved, Humana will provide you with all the necessary information about your chosen SNP. Review the plan details carefully, paying attention to coverage, benefits, and any additional services offered. 

Signing up for a Humana Special Needs Plan can significantly improve your access to medical services and assistance. By taking these measures, you'll be positioned to choose a plan tailored to your individual requirements, guaranteeing you get the necessary care.

Maximize Your Humana Benefits With a Grocery Allowance

Taking full advantage of the benefits offered by Humana can not only elevate your healthcare experience but also bring added perks to support your overall well-being. From comprehensive health coverage to unique benefits like the Humana grocery card, there's a wealth of opportunities to ensure you're making the most of your health plan.

Don't miss out on maximizing your benefits. Explore how the Humana grocery card can enhance your health journey and check out other offerings. Learn how to use your Humana card for free groceries!

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Nathan Justice manages community outreach programs and forums that help many senior citizens. He completed a counseling program at the University of Maryland’s Department of Psychology.
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