Understanding Medicare Special Needs Plans in Miami County, Ohio
Explore 27 Medicare Special Needs Plans (SNPs) available in Miami County for 2025. These plans are designed for individuals with specific healthcare needs, including chronic conditions, long-term care, or dual eligibility for Medicare and Medicaid.
Ready to explore your Special Needs Plan options further? Speak with a licensed HealthCompare agent today at 1-833-748-3201 (TTY 711).
Compare the available plans below, or call 1-833-748-3201 (TTY 711) to speak with a licensed HealthCompare agent for personalized help.
Exploring Available Special Needs Plans in Miami County
Medicare Special Needs Plans (SNPs) are customized to address various healthcare needs. There are different types of SNPs, each created to offer tailored benefits for specific groups of individuals, but some areas of Ohio will not have all plan types:
- Dual Eligible SNP Plans (D-SNP): Miami offers 17 D-SNP plans. They combine Medicare and Medicaid benefits to simplify healthcare management. The average premium for these plans is $13.31. The premium on most D-SNP plans is covered in full by Medicaid.
- Chronic Condition SNP Plans (C-SNP): There are 2 C-SNP plans in Miami County. The average premium for these plans is $0.00. C-SNPs provide specialized care for individuals with chronic health conditions.
- Institutional SNP Plans (I-SNP): Miami County has 4 I-SNP plans available. These plans are designed for individuals living in long-term care facilities or those who require ongoing skilled nursing care.
- Medicare Advantage Plans: If you don't qualify for a SNP Plan or you can't find one that meets your needs, a traditional Medicare Advantage plan is another option. We organize these plans here: Medicare Advantage Plans in Miami County, OH.
Dual Eligible Special Needs Plans (D-SNPs)
These plans are designed for those who qualify for both Medicare and Medicaid. They simplify healthcare management by offering comprehensive benefits that cover services from both programs. The Medicare Plan Compare tool on Medicare.gov is another valuable resource to help you understand your options.
Miami County, Ohio D-SNP Options
| Plan Name | Rating* | Premium/Mo | Network | |
|---|---|---|---|---|
| The Health Plan SecureCare SNP | $35 | HMO D-SNP | ||
| Aetna Medicare Assure 1 | $0 | HMO D-SNP | ||
| UHC Dual Complete OH-D002 | $39 | HMO-POS D-SNP | ||
| UHC Dual Complete OH-V002 | $39 | HMO-POS D-SNP | ||
| Anthem Dual Advantage | $19 | HMO D-SNP | ||
| Anthem Full Dual Advantage | $0 | HMO D-SNP | ||
| Anthem Full Dual Advantage 2 | $0 | HMO D-SNP | ||
| CareSource Dual Advantage | $0 | HMO D-SNP | ||
| Humana Gold Plus SNP-DE H6622-015 | $0 | HMO D-SNP | ||
| Humana Gold Plus SNP-DE H6622-087 | $0 | HMO D-SNP | ||
| HumanaChoice SNP-DE H5525-046 | $39 | PPO D-SNP | ||
| Wellcare Dual Access | $0 | HMO-POS D-SNP | ||
| Wellcare Dual Reserve | $36 | HMO-POS D-SNP | ||
| Molina Medicare Complete Care | $0 | HMO D-SNP | ||
| Cigna TotalCare | $18 | HMO D-SNP | ||
| Cigna TotalCare Plus | $0 | HMO D-SNP | ||
| UHC Dual Complete OH-S3 | $0 | HMO-POS D-SNP | ||
| * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. | ||||
- Medicaid Eligibility: D-SNPs are designed for individuals who qualify for both Medicare and Medicaid. Ensure that you meet the eligibility requirements for Medicaid in your state.
- Question to ask: Am I eligible for Medicaid benefits in addition to Medicare?
- Provider Network: Confirm that your preferred healthcare providers, including doctors and hospitals, are part of the D-SNP plan's network to avoid out-of-network costs.
- Question to ask: Are my doctors and hospitals in this plan’s network?
- Integrated Benefits: D-SNPs integrate Medicare and Medicaid benefits, which can simplify your healthcare management. Check what specific benefits are included in your plan.
- Question to ask: What additional benefits are provided by this D-SNP plan?
- Prescription Drug Coverage: Most D-SNPs include prescription drug coverage. Review the formulary to ensure your medications are covered.
- Question to ask: Does this plan cover my current prescriptions?
Institutional Special Needs Plans (I-SNPs)
Designed for individuals living in long-term care facilities, like nursing homes, or those needing prolonged skilled nursing care at home, these plans offer specialized coverage. You can find more information about I-SNPs and their benefits on the CMS website.
Miami County, Ohio I-SNP Options
| Plan Name | Rating* | Premium/Mo | Network | |
|---|---|---|---|---|
| UHC Care Advantage OH-E001 | $39 | PPO I-SNP | ||
| UHC Nursing Home Plan OH-F001 | $39 | PPO I-SNP | ||
| Valor Health Plan | $39 | HMO I-SNP | ||
| Humana Together in Health | $0 | PPO I-SNP | ||
| * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. | ||||
- Long-Term Care Needs: I-SNPs are designed for individuals in long-term care facilities or those needing ongoing skilled nursing care. Ensure the plan covers the level of care you require.
- Question to ask: Does this plan cover my specific long-term care needs?
- Facility Network: Confirm that the long-term care facilities or skilled nursing providers you prefer are in the plan’s network to avoid out-of-network costs.
- Question to ask: Are my preferred care facilities and providers in-network?
- Care Team Support: I-SNPs often include dedicated care teams to coordinate your care. Verify that the plan provides access to a care team that meets your needs.
- Question to ask: Will I have access to a dedicated care team under this plan?
- Prescription Drug Coverage: Most I-SNPs include prescription drug coverage. Check the plan’s formulary to ensure that your medications are covered.
- Question to ask: Are my medications covered, and what are the copays?
Chronic Condition Special Needs Plans (C-SNPs)
These plans are designed for individuals with severe or disabling chronic conditions. C-SNPs excel at coordinating your care among different medical specialists and often include extra benefits like prescription drug plans.
Miami County, Ohio C-SNP Options
| Plan Name | Rating* | Premium/Mo | Network | |
|---|---|---|---|---|
| UHC Complete Care OH-18 | $0 | HMO-POS C-SNP | ||
| Humana Gold Plus - Diabetes and Heart | $0 | HMO C-SNP | ||
| * Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system. | ||||
- Chronic Condition Management: C-SNPs are designed for individuals with specific chronic conditions. Make sure the plan covers your condition and offers specialized care that meets your needs.
- Question to ask: Does this plan provide specialized care for my chronic condition?
- Care Coordination: C-SNPs often provide coordinated care among different healthcare providers. Verify that the plan includes access to specialists who treat your condition.
- Question to ask: Does this plan offer coordinated care with specialists I need?
- Extra Benefits: C-SNPs may offer additional benefits such as wellness programs or disease management services.
- Question to ask: What extra benefits does this C-SNP plan offer for managing my condition?
- Prescription Drug Coverage: C-SNPs generally include prescription drug coverage. Review the formulary to ensure your medications are covered and affordable.
- Question to ask: Are my medications covered, and what are the associated costs?
How and When to Enroll in a Medicare SNP Plan in Miami County
Choosing the right Medicare Special Needs Plan (SNP) in Miami County depends on enrolling at the right time. Understanding the different enrollment periods will help ensure that you get the coverage that best meets your needs.
When to Enroll
- Initial Enrollment Period (IEP): Starting three months before your 65th birthday and lasting until three months after, this is your first chance to enroll in Medicare. Learn more: Medicare IEP Guide.
- Medicare Advantage Open Enrollment Period (MA OEP): Between January 1 and March 31, you can switch your Medicare Advantage Plan, including SNPs, so long as you are currently enrolled in a Medicare Advantage plan. Learn more: MA OEP Guide.
- Annual Enrollment Period (AEP): From October 15 to December 7, this period allows most people to adjust their Medicare plans. Learn more: AEP Guide.
- Special Enrollment Periods (SEPs): If you qualify due to certain life events, such as moving or losing other coverage, you may be eligible for a Special Enrollment Period. Learn more: SEP Guide.
How to Enroll
When you're ready to enroll in a Medicare Special Needs Plan, here are your options:
- Consult a Licensed Agent: Speak with a licensed HealthCompare agent at 1-833-748-3201 (TTY 711) for personalized guidance.
- Contact the Plan Provider Directly: Visit the provider's website or call their customer service for enrollment details.
- Use Medicare.gov: Compare plans and enroll online at Medicare.gov.
FAQs about Medicare Special Needs Plans in Miami County
What is a Medicare Special Needs Plan (SNP)?
A Medicare Special Needs Plan (SNP) is a type of Medicare Advantage Plan designed to meet the specific needs of individuals in Miami County who have chronic conditions, live in long-term care facilities, or qualify for both Medicare and Medicaid.
How do SNPs differ from regular Medicare Advantage plans?
Unlike standard Medicare Advantage Plans, SNPs provide specialized benefits and care coordination tailored to individuals with unique healthcare needs, such as chronic illnesses or dual eligibility for Medicare and Medicaid.
Can I switch to an SNP if I’m already enrolled in a different Medicare plan?
Yes, switching to an SNP is possible during the Annual Enrollment Period (AEP) or during a Special Enrollment Period (SEP) if you qualify due to a life event, such as moving or losing coverage.
What types of chronic conditions qualify for a Chronic Condition SNP (C-SNP)?
If you have a chronic condition like diabetes, heart disease, or chronic obstructive pulmonary disease (COPD) and reside in Miami County, you may qualify for a Chronic Condition SNP (C-SNP). Check the specific plan details to ensure coverage for your condition.
How do I find out if my doctors and medications are covered by an SNP?
You can verify whether your doctors and prescriptions are covered by reviewing the plan’s provider network and drug formulary. This information is usually available on the plan’s website or through customer service.
Can I enroll in an SNP at any time, or do I have to wait for an enrollment period?
Enrollment in an SNP in Miami County is generally limited to specific periods, such as the Initial Enrollment Period (IEP), Annual Enrollment Period (AEP), or Medicare Advantage Open Enrollment Period (MA OEP) for Medicare beneficiaries currently enrolled in a Medicare Advantage plan. Special Enrollment Periods (SEPs) may also be available if you experience certain qualifying events.
The D-SNP, C-SNP, and I-SNP plans listed on this page are available to qualifying individuals enrolled in Medicare Part A and Part B living in Bradford, Casstown, Conover, Covington, Fletcher, Laura, Ludlow Falls, Piqua, Pleasant Hill, Tipp City, Troy, West Milton, and all other areas of Miami County, Ohio.
Plans Offered for Enrollment through Medicare.org
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.