The Essentials of Selling Special Needs Plans

Agent with Senior Couple in front of window showing four seasons

The hardest part of selling special needs plans, or SNPs, is knowing the size of your market. Medicare Special Needs Plans are available to a larger population than you may think. More than 80 percent of seniors may qualify for SNP coverage, including those with certain chronic conditions, those who live in nursing homes, and those who are eligible for both Medicare and Medicaid.

What Are SNPs?

SNPs are Medicare Advantage Coordinated Care Plans designed to provide targeted care to those with certain needs other Medicare plans won’t cover. When selling special needs plans, it’s important to know the basics of the three special needs plan types, which have specifically designed coverage and resources to help their members manage their health. Below is a breakdown of the three SNP Medicare categories.

  • Chronic Condition Special Needs Plans (C-SNPs): These special needs plans limit enrollment to people with special needs who have specific, severe, or disabling chronic conditions. These plans help beneficiaries manage their chronic diseases, monitor their health status, avoid inappropriate hospitalizations, and improve their health status from high risk to lower risk.
  • Dual Eligible Special Needs Plans (D-SNPs): Medicare Dual Eligible Special Needs Plan beneficiaries are eligible for both Medicare and Medicaid benefits.
  • Institutional Special Needs Plans (I-SNPs): Medicare Institutional Special Needs Plans limit enrollment to people who are eligible for Medicare Advantage who have had, or will need, at least 90 days in a long-term care or skilled nursing facility, an intermediate care facility for individuals with intellectual disabilities, or an inpatient psychiatric facility.

Benefits of SNP Medicare for Your Clients

Selling special needs plans to your clients and helping them get the best coverage for their needs can help them better manage their chronic conditions and improve their overall health outlook. SNP Medicare benefits differ depending on which type of plan the member is enrolled in. SNP coverage includes:

  • Medically necessary and preventive services covered under Medicare Part A and Part B
  • Prescription drug coverage under Part D

Research has shown that beneficiaries who enrolled in a Medicare Advantage special needs plan instead of a traditional Medicare plan experienced benefits that helped them better manage their health and control costs. For example, a Health Affairs study found that diabetic beneficiaries had “lower admission rates, shorter average lengths-of-stay in the hospital, [and] lower readmission rates.”

Selling Special Needs Plans Year-Round

Selling special needs plans can be a year-round selling opportunity. These plans offer a steady market and a good reason to keep in regular contact with your clients. The diagnosis of a qualifying condition can trigger a special election period (SEP) and allow you to reevaluate coverage with your clients. Carrier resources are available to verify a person’s eligibility for the plans at the time of sale.

Remember that plans require their members to provide periodic proof that they continue to meet the criteria required for enrollment in an SNP. If your client loses eligibility for a plan, the client will have an SEP that continues for two months after the special needs plan coverage ends.

Also remember the follow the Medicare Marketing Guidelines regarding Special Needs Plan Disclaimers, when and how to use NCQA special needs plan approvals in marketing materials, I-SNP marketing requirements, and D-SNP disclaimers.

How Excelsior Can Help Brokers

It’s estimated that nearly 11,000 individuals are aging into Medicare daily, and Excelsior’s regional sales directors can help you penetrate the SNPs market. And even if these new additions don’t qualify for a special needs plan, they are still looking for help.

Excelsior offers access to the biggest brands in the business, provides guidance on cross-selling senior products, and gives training support to our brokers. We also offer an expanding portfolio of carriers, exclusive low-cost leads, and multi-carrier, multi-product quoting resources. Engage with Excelsior today.


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