Special Needs Plans

What Are Special Needs Plans (SNPs)?

Universal Health Care offers Medicare Advantage Special Needs Plans (SNP) for beneficiaries who are dual eligible (have Medicare and Medicaid), or who have one of the following chronic conditions: Diabetes, Cardiovascular disease (CVD) or Chronic Heart failure (CHF). SNPs are designed to serve Medicare beneficiaries with special needs through improved coordination and continuity of care. These plans offer eligible beneficiaries focused services such as an annual health risk assessment, an individualized care plan, and an interdisciplinary care team approach to managing care.

What Types of Special Needs Plans Does Universal Offer?

Dual Eligible - Medicare & Medicaid

The following plan has been designed to serve beneficiaries who are dual eligible for Medicare and Medicaid benefits:

Universal Trust (HMO SNP) [Dual]

Available in the following counties in Texas: Bexas, Collin, Dallas, Denton, Galveston, Harris, Montgomery, Tarrant

Severe & Chronic Conditions

The following plan has been designed to serve beneficiaries with one of the following severe or disabling chronic conditions - Diabetes, Cardiovascular Disease (CVD), Chronic Heart Failure (CHF):

Universal Healthy Living (HMO SNP) [CVD, CHF, Diabetes]

Available in the following counties in Texas: Bexar, Collin, Dallas, Denton, Galveston, Harris, Montogomery, Tarrant

Available in the following counties in Nevada: Clark

How Can You Qualify for the Special Needs Plan?

You can join a Medicare SNP if you qualify for Medicare Part A and are enrolled in Medicare Part B, live in the Plan's service area, and meet one of the following requirements:

• You have one or more of the following chronic or disabling conditions: Diabetes, Cardiovascular Disease, or Chronic Heart Failure, (see above for specific availability) or
• You have both Medicare and Medicaid.

To find out more about Special Needs Plans or see if you qualify, please contact us.

Important Plan Information

• For the Dual Eligible SNP, premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you may receive for Part D covered drugs.
• SNPs may enroll eligible beneficiaries at other times of the year besides the annual enrollment period. All beneficiaries must meet eligibility criteria and have a valid election period.
• The Medicare Part B premium is covered for Qualified Medicare Beneficiaries (QMB), Specified Low-income Medicare Beneficiaries (SLMB), and Qualified Individuals (QI) by the State Medicaid Agency as long as members remain eligible for assistance from Medicaid.
• You must use plan providers except in emergent or urgent-care situations. If you obtain routine care from out-of-network providers, neither Medicare nor Universal Health Care will be responsible for the costs.
• Referrals may be required for specialists and hospitalizations. Check plan documents for details.