Examples
Josephine, age 82, lives with
her daughter and has multiple medical
problems. She has a history of serious drug
reactions, including a recent event that caused
her to be hospitalized. Josephine’s daughter
learned about a new type of Medicare health
plan, called a Special Needs Plan (SNP), that is
specifically designed to work with people who
have complex medical needs. It provides all of
Josephine’s Medicare Parts A & B coverage, as
well as her Medicare drug coverage. The daughter
learns that all but one of her mother’s medications
are covered under the SNP’s formulary.
The daughter, with the help of her mother’s
doctor, applies to the SNP for an exception to
the formulary and it is granted because of her
mother’s medical needs. In addition, the SNP
provides a care manager who helps coordinate
all of Josephine’s health care needs and ensures
that her doctors have the information they need
to treat her effectively.
Josephine also qualifies for extra help in paying
for both her prescription drug costs and the rest
of her medical costs. As a result, she does not
have to pay a monthly premium for her prescription
drug plan or an annual deductible. She also
gets continual coverage for her prescriptions
through the coverage gap. She will pay:
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