unitedhealthcare dual complete az

unitedhealthcare dual complete az

A unitedhealthcare dual complete az
Special needs strategy (SNP) is a Medicare Advantage (MA) coordinated care program (CCP) specially designed to provide targeted care and limit enrollment to
special needs individuals. Special needs individual could be any of
the following:

  1. An institutionalized
    person,
  2. A dual qualified, or
  3. An individual having a
    serious or disabling chronic condition, as specified by CMS.

A SNP may be any type of MA CCP, such as either a local or regional preferred provider organizations (i.e., LPPO or RPPO) plans, a health maintenance organization (HMO) program, or a HMO Point-of-Service (HMO-POS) program.

There are 3 different types of SNPs:

  1. Chronic Condition SNP
    (C-SNP)
  2. Dual Eligible SNP
    (D-SNP)
  3. Institutional SNP
    (I-SNP)

MA regulations at 42 CFR 422, as altered by advice, with respect to
Medicare-covered services and Prescription Drug Benefit application rules.
All SNPs must offer Part D prescription drug coverage because particular needs people must have access to prescription medication to control and manage their particular health care needs. SNPs should presume that, if no
modification is contained in guidance, present Part C and D principles apply.

Payment SNPs must prepare and submit bids such as other MA plans,
and are paid in the same manner as other MA plans depending on the plan’s
registration and risk adjustment payment methodology. All of SNPs must abide
by present CMS advice on cost sharing requirements.

Some Special Needs
Plans include care-coordination services to help you understand your
illness and follow your physician’s treatment regimen. Or you may have
access to health programs to aid with a special diet or other lifestyle
activities which can help improve your condition.

Chronic-Condition Special
Needs Plans may include supplier networks with physicians and hospitals that
specialize in treating the particular state of its associates, or else they may have formularies which are tailored to include the prescription medications that treat that illness. If you are enrolled in a Special Needs Plan for dual eligibles, then there could be specific social services available to assist you coordinate your Medicare and Medicaid benefits.

It is important to note

That you still get all the coverage that’s otherwise comprised with Original
Medicare, Part A and Part B, and Medicare Part D. The Special Needs Plan simply
offers extra coverage to help you better manage your specific situation,
whether that is living in a nursing home; coordinating your Medicare and
Medicaid benefits; or treating a serious chronic illness.

1 key difference
Involving a Special Needs Plan and other forms of Medicare Advantage plans is
that all Special Needs Plans should cover prescription drugs. In contrast, other
Medicare Advantage plans (by way of example, HMOs and PPOs) may or may not contain prescription drug coverage, depending on the particular plan.

Medicare Advantage
Based on the
Special Needs Plan, you may typically have the following costs:

Medicare Part B premium

Monthly premium for your
Special Needs Plan

Prescription drug coverage (in case your SNP requires it)

Additional advantages (if your SNP requires it)
Cost-sharing Costs, such as
copayments, coinsurance, or deductible

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