If you live in a nursing home you can qualify for Special Needs Medicare Advantage plan that is specially designed for these needs. Because of the Medicare needs of someone in an assisted living facility, you can join these Health Plans all year long.
Plan for People with Limited Income
This is a plan offered for people enrolled in Medicare and who are enrolled in Medicaid (or “dual eligible” and receive assistance from the State for their health coverage).
These plans have benefits geared to people living in community settings and are designed to help them receive the preventive care they need, including coverage for hospital and shorter-term nursing home stays. Here's are some of the benefits of this plan:
- Includes a built-in prescription drug coverage (Part D) often at no additional premium if you are receiving the Low Income Subsidy (LIS) because of your Medicaid coverage
- Provides additional benefits, like preventive care, that Original Medicare doesn't cover
- No medical copayments or cost-sharing if you are receiving Full Medicaid Benefits
- Keep your existing Medicaid benefits
- Access to care management support
These plans are designed to work with your existing state coverage. If you receive state medical assistance, this plan may be a better choice for your Medicare coverage.
Find a Doctor, Facility, or Medical Group/Network
Before signing up for this Medicare Advantage plan, you want to be sure that there are enough doctors in your area who accept the plan. Click this link to review the doctors and hospitals who accept UnitedHealthcare, one of the most popular carriers offering Special Needs Plans. Or contact us and we'll be happy to check the physician list for any plans available in your area.
Search the drug list
A formulary, or drug list, is a list of prescription medications that are covered under a health plan that offers prescription drug (Part D) coverage.
A formulary or drug list is a list of prescription drugs covered by your Medicare Part D plan. This list of covered medications can help you and your physician maximize your plan benefits while minimizing your overall prescription drug costs. A formulary makes it easier for your physician to select a medication that will be covered by your plan. This means you will be able to obtain your medicine at your pharmacy of choice more quickly. You will want to carefully weigh the differences in drug lists against the plan costs and other features when choosing a plan that may best meet your needs.
Generic drugs: The drug formulary covers both brand-name and generic drugs. A generic drug typically is less expensive and is sold under a generic name for that drug (usually its chemical name). Because generic drugs are less expensive than their brand-name equivalent, your copayment usually is less, as well.
Coverage limitations: To be covered, drugs must be prescribed for a use that is approved by the FDA or documented in at least one of the specific peer-review compendia identified by the Centers for Medicare and Medicaid Services (CMS). You can find out if any additional coverage limitations apply to the coverage of your drug by reviewing the UnitedHealthcare Formulary (Covered Drugs List). (We can also check other carrier lists for you). Prior authorization requires you or your doctor to get approval from the plan before your drug is covered. View the prior authorization criteria PDF below that applies to your plan to determine if the drug is covered. You will need the free Adobe® Reader® software to view this document.
Coverage determination and exceptions: A coverage determination is a decision made by your plan regarding payment for a drug or the types of drugs covered as part of your benefit. If you wish to have the plan review its coverage decision based on your individual circumstances, you may request an exception to a coverage determination.
Getting Quotes and Signing
For quotes and assistance with enrollment, click here to request a free telephone consultation.
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Disclaimer: Medigap Advisors is not connected with or endorsed by the U.S. Government or the federal Medicare program. Medicare has neither reviewed nor endorsed the information contained on this website. This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE or consult www.medicare.gov (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week.