Special Need Plans
Medicare is a low-cost health insurance plan that is federally funded. Most people get it when they turn 65. You may be eligible before you turn 65 if you have a disability, End-Stage Renal Disease (ESRD), or ALS (also known as Lou Gehrig’s disease). We have plans that cover everything Original Medicare does, but with added enhancements and benefits to help you pay for the things it doesn’t cover, which will save you money.
Original Medicare is made up to two parts, Part A and Part B. Each Part pays for different parts of your care.
- Inpatient Hospital Care
- Skilled Nursing Facility
- Lab Tests
- Home Health Care
- Doctor Services and Outpatient Care
- Durable Medical Equipment
- Home Health Care
- Some Preventive Services
You may have to pay a premium for Part A, but most people do not. If you or your spouse paid taxes into Medicare while you were working, you will not have to pay premiums for Part A.
The cost of Part B will vary depending on your income. Social Security uses your tax information to find out what you should pay. You may qualify for reduced Part B premiums.
There are many services that Original Medicare covers, but it does not pay for everything.
|Prescription Drugs are not covered by Original Medicare||Regular Vision Exams, eyeglasses or contacts||Most Dental Care||Hearing aids and exams for fitting them||Other Supplemental Benefits and Services|
GLOBALHEALTH HAS SEVERAL MEDICARE ADVANTAGE COVERAGE OPTIONS THAT COST $0 PER MONTH THAT WILL PROVIDE COVERAGE FOR THINGS THAT ARE NOT COVERED BY ORIGINAL MEDICARE. WE CAN HELP SAVE YOU MONEY.
A Medicare Advantage plan is an all-in-one alternative to Original Medicare to enhance your health coverage. Medicare Part C, such as a plan from GlobalHealth, combines Part A and Part B and often Part D prescription drugs. Medicare Part C usually offers more benefits for services such as dental, vision, hearing and low to no copays on physician visits. You must have Medicare Parts A and B to enroll in a Medicare Advantage plan.
|Part C||Part D||Additional Benefits|
- Do you have Part B?
- Do you have Part A?
- Are you a permanent resident within our Service Area?
If you answered YES to all three questions, then You Likely Qualify!
Annual Enrollment Period - October 15 thru December 7
- This period is the window of time in which Medicare beneficiaries can join, switch, or disenroll from a Medicare Advantage plan. Changes to enrollment made during this period will be effective January 1, 2023.
Open Enrollment Period - January 1 thru March 31
- Medicare Advantage plan enrollees have one opportunity during this period to enroll in another Medicare Advantage plan or to disenroll from their Medicare Advantage plan and return to Original Medicare.
Special Enrollment Period - April 1 thru October 14
- Medicare beneficiaries cannot make changes to their current plan unless they qualify for a special enrollment period.
Are you turning 65 years of age?
You can enroll in a Medicare Advantage plan during a 7-month window around your 65th birthday :
- 3 months before you turn 65.
- The month you turn 65.
- 3 months after your birthday month.
Other qualifying events may allow a Medicare beneficiary to make plan changes throughout the year. If you can answer “Yes” to any of the following questions, you may qualify to make a plan change.
- Do you have both Medicare and Medicaid?
- Do you qualify for Extra Help paying for your prescriptions?
- Have you recently moved and your current plan is not offered in your service area?
- Are you leaving your employer or union coverage?
- Do you qualify for a special needs plan for diabetes, chronic heart failure, or cardiovascular disease?
IF YOU THINK YOU MAY HAVE ANOTHER QUALIFYING EVENT THAT IS NOT LISTED HERE, CONTACT US AND WE WILL HELP YOU DETERMINE IF YOU QUALIFY.
Special Needs Plans
GlobalHealth is excited to have the opportunity to offer a Special Needs Plan (SNP) to those that qualify. A SNP offers an array of services and benefits that are designed for people who have certain chronic conditions or are dual-eligible (receive both Medicare and Medicaid benefits).
- Chronic Special Needs Plans (C-SNP)
- Dual Special Needs Plans (D-SNP)
Chronic Special Needs Plans (C-SNP)
A C-SNP is a type of Medicare Advantage plan designed for Medicare beneficiaries with chronic conditions such as heart disease or diabetes. Plans may offer C-SNP plans for only one condition or a group of conditions.
The Centers for Medicare and Medicaid Services (CMS) defines which condition(s) a Medicare Advantage plan may cover through a C-SNP plan. For 2023, GlobalHealth is offering C-SNP plans that will cover:
- Chronic Heart Failure
- Cardiovascular Disease, including cardiac arrhythmias, coronary artery disease, peripheral vascular disease, and chronic venous thromboembolic disorders
Members enrolled in a C-SNP plan typically receive lower out-of-pocket for prescriptions and other services due to the level of integration with Medicaid.
GlobalHealth C-SNP Features and Benefits:
- Standard Diabetic Testing Supplies Covered at No Cost
- Three pair of Therapeutic Custom-Molded Shoes and Inserts*
- $35 Copay for Select Insulins through the Part D Senior Savings Model
- Additional Coverage for Tier 3 Oral Antidiabetics through the Gap Coverage Stage
Dual Special Needs Plans (D-SNP)
Dual Special Needs Plans (D-SNP) are a unique type of Medicare Advantage plans that provides benefits for people that are eligible for Medicare (Part A & Part B) and Medicaid, incorporating medical, pharmacy, and behavioral health.
Medicare beneficiaries that are categorized as a Qualified Medicare Beneficiary (QMB) or Specified Low-Income Medicare Beneficiary (SLMB) qualify for at least one type of D-SNP that is offered at GlobalHealth.
Our D-SNP Model of Care is designed to provide improved management of your health benefits by providing and arranging for Medicaid benefits.
Examples of additional benefits may include:
- $0 monthly premiums
Care Management and Coordination
Dental, Vision, and Hearing coverage
Also included are transportation assistance, Companion Care assistance and more.
|Step||How you receive this||Why you receive this|
|1. Enrollment Verification Letter||To assure you that we received your completed enrollment form.(Please Note: Medicare still need to approve your enrollment.)|
|2. Notice to Confirm your Enrollment||To confirm your enrollment was approved by Medicare.|
|3. Welcome Kit||To provide you with a Welcome Kit that has plan information, including information about where to find your Evidence of Coverage.|
|4. Member Id Card||To provide you with a Member ID Card. You need to show this card every time you visit the physician, hospital or pharmacy.(if applicable)|
|5. Health Risk Assessment (HRA)||This information will allow GlobalHealth to coordinate with your health care providers in a way that best serves your preventive health care need.|
Sometimes life takes you to new places. Changing your address is easy. Simply call the GlobalHealth Customer Care team and provide them with your new address.
What can I do if I move?
If you move to a new city that is within your plan’s network, you can:
- Keep your current Medicare Advantage of Part D plan.
- Enroll in or change to a difference Medicare Advantage or Part D plan
- Disenroll from your existing plan and return to original Medicare.
If you have a Medicare Advantage plan, you can either enroll in a new Medicare Advantage or go back to Original Medicare and enroll in a Part D plan. You will have the following options:
- Enroll in a new Medicare Advantage plan
- Enroll in a new Part D plan
- Drop your Medicare Advantage coverage and return to Original Medicare when you move.
What is Extra Help?
Extra Help (also known as Low-Income Subsidy (LIS)) helps pay for a portion of your prescription drug costs, including Part D premiums, deductibles, and copays.
Do I qualify for Extra Help?
- To be eligible for Extra Help, you must:
- Live in the United States
- Be enrolled in Medicare Part A and Part B
- Have less than $19,320 in annual income/$15,510 in assets (if you’re single)
- Have less than $26,130 in annual income/$30,950 in assets (if you’re married)
How Can I apply for Extra Help?
To get Extra Help, you must complete and submit and application to the Social Security Administration. Click Here to apply for Extra Help now.
The Late Enrollment Penalty (LEP) is an amount that is permanently added to your Medicare drug coverage (Part D) premium. You may owe a late enrollment penalty if at any time after your Initial Enrollment Period is over, there’s a period of 63 or more days in a row when you don’t have Medicare drug coverage or other creditable prescription drug coverage.
You may be able to ask for a “reconsideration”. CLICK HERE to download the form. Complete the form, and return it to the address or fax number listed on the form.
CLICK HERE to download Coordination of Benefits (COB) Survey.
Importance of letting GlobalHealth know you have other Health Insurance.
Coordination of benefits (COB) allows GlobalHealth to determine their respective payment responsibility (i.e., determine which insurance plan has the primary payment responsibility and the extent to which the other plans will contribute when an individual is covered by more than one plan).
This will ensure claims are paid correctly by identifying the health benefits available to a Medicare beneficiary, coordinating the payment process, and ensuring that the primary payer, whether Medicare or other insurance, pays first.
We are High-touch.
Our local customer care, case management and pharmacy teams provide you with personal assistance to help you move through the increasingly complex world of Medicare. We are approachable, easy to reach and go above beyond to help you.
We are Affordable.
We offer a number of money-saving benefits designed to keep more money in your pocket and extend your dollars on your medical expenses.
We are your Health Partner.
Not only will we help enroll you in the right plan, but you'll also have ongoing access to tireless health advocates who support your best health, even between doctor visits.