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Chronic Condition Special Needs Plans

Care Improvement Plus’ Chronic Conditions Special Needs Plans

Care Improvement Plus’ Chronic Conditions Special Needs Plans (C–SNP) are uniquely designed for Medicare beneficiaries with diabetes and/or heart failure.

With money–saving medical and prescription drug coverage, health education, and a variety of valuable extra benefits and services, Care Improvement Plus’ Chronic Conditions Special Needs Plans help Medicare beneficiaries take steps to better manage their daily health.

Care Improvement Plus currently offers two C–SNP plan options:

  • Silver Rx (Regional PPO SNP)(PPO SNP) – for those Medicare beneficiaries with diabetes and/or heart failure who also have full Medicaid.
  • Gold Rx (Regional PPO SNP)(PPO SNP) – for Medicare beneficiaries with diabetes and/or heart failure who do NOT receive full Medicaid benefits.
Why offer a health plan for those in Medicare with chronic health conditions?

According to a recent Congressional Budget Office report, beneficiaries with multiple chronic conditions currently account for 81 percent of Medicare spending1. These beneficiaries have complex health care needs such as multiple prescriptions to manage and numerous doctors. In addition, beneficiaries with chronic conditions are at a higher risk of developing complications and requiring hospitalization. C–SNPs provide customized support and added benefits aimed at improving the quality of care provided to these beneficiaries, and helping to control their health care costs.

Key Diabetes and Heart Failure Statistics:
  • Among U.S. residents aged 65 years and older, 10.9 million, or 26.9%, had diabetes in 20105
  • The total cost of diagnosed diabetes in the United States in 2007 was $174 billion2
  • Nearly 26 million Americans currently have diabetes; an increase of three million in the last two years and the number of people with diabetes throughout the world is expected to double by 20305
  • People ages 60 years or older account for 23.1% of the population with diabetes4
  • Heart failure cardiovascular disease is the number one cause of death for people age 75 and older6

Key Statistics on the Power of Chronic Care Management:
  • Complex case management services for beneficiaries with diabetes can reduce the rate of hospital admissions by over 50%. 43
  • A 12 to 13 point reduction in blood pressure can reduce the incidence of heart attacks by 21%, strokes by 37%, and the total number of cardiovascular disease deaths by 25 %.43
  • Improved blood sugar control in people with diabetes can reduce their risk of developing diabetic complications such as blindness, kidney disease and nerve damage (which can lead to amputation) by 40%.3

Sources:


This page was last updated on: 8/23/2011 10:15:16 AM
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Care Improvement Plus is a Medicare Advantage organization with a Medicare contract. The Care Improvement Plus contract with CMS is renewed annually and coverage availability beyond the end of the current contract year is not guaranteed. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change on January 1, 2013.

The benefit information provided herein is a brief summary, but not a comprehensive description of available benefits. For more information contact the plan. To be eligible for a Care Improvement Plus plan you must be a Medicare beneficiary living in Arkansas, Georgia, Missouri, South Carolina, Texas and select counties in Illinois, Iowa, Indiana, Maryland, New Mexico, New York, Wisconsin and have both Medicare Part A and Part B to enroll.

To be eligible for a Care Improvement Plus Chronic Conditions Special Needs Plan, you must have diabetes and/or heart failure. To be eligible for Care Improvement Plus Dual Advantage, you must be enrolled in state Medicaid and be a dual eligible beneficiary whom the State holds harmless for Part A and Part B cost sharing.

Members may enroll in the plan only during specific times of the year. Contact Care Improvement Plus for more information. If you have diabetes, heart failure, or Medicaid/Low Income Subsidy, you may qualify to enroll in a Care Improvement Plus Special Needs Plan ANYTIME of the year by exercising a “Special Election Period.

You must continue to pay your Medicare Part B premium. If you are a full benefit dual beneficiary and your Part B premium is paid for by the State, you will not be responsible for paying your Part B premium. Premiums, copays, coinsurance and deductibles may vary based on the level of help received. Limitations, copayments and restrictions may apply.

You may be able to get extra help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:

  • 1–800–MEDICARE (1–800–633–4227). TTY users should call 1–877–486–2048, 24 hours a day/7 days a week;
  • The Social Security Office at 1–800–772–1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1–800–325–0778; or
  • Your State Medicaid Office.

People with limited incomes may qualify for extra help to pay their prescription drug costs. If eligible, Medicare could pay for 75% or more of your drug costs including monthly prescription drug premiums, annual deductibles, and coinsurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about this extra help, contact your local Social Security office, or call Social Security at 1–800–772–1213.TTY users should call 1–800–325–0778. You can also apply for extra help online at www.socialsecurity.gov/prescriptionhelp. If you qualify for extra help with your Medicare prescription drug coverage costs, Medicare will pay all or part of your plan premium. If Medicare pays only a part of this premium, we will bill you for the amount that Medicare doesn’t cover.

Premiums, copays, coinsurance, and deductibles may vary based on the level of help that beneficiaries may receive. Contact the plan for further details. Eligible beneficiaries must use network pharmacies to access their prescription drug benefit, except under nonroutine circumstances, and quantity and restrictions may apply. It may cost more to get care from out–of–network providers, except in an emergency. If there isn’t a network provider available for you to see, you can go to an out–of–network provider but still pay the in–network amounts except for members who live in our Maryland service areas. Those members can only use doctors, specialists, or hospitals in–network. The health providers in our network can change at any time.