At Freedom Health, we understand that every individual has unique healthcare needs. That’s why we offer a range of specialized insurance solutions designed to provide personalized coverage and customized benefits to meet your specific requirements. Our tailored health plans are crafted to empower you to actively manage your well-being and access the care you need, when you need it.

Freedom Health’s Special Needs Plans (SNPs) are specifically tailored for individuals with certain chronic diseases or those who are dually eligible for both Medicare and Medicaid benefits. These plans include our Chronic Combined SNP for members with diabetes, cardiovascular disease, or chronic/congestive heart failure, as well as our Chronic Pulmonary SNP for those with chronic lung disorders. Additionally, our Dual Eligible SNP caters to members who receive both Medicare and Medicaid coverage.

By offering personalized coverage, flexible plans, and customized benefits, Freedom Health ensures that your individual health needs are at the forefront of your healthcare experience. Whether you’re seeking bespoke healthcare solutions or specialized insurance options, our tailored policies are designed to provide the support and resources you need to live your healthiest life.

Key Takeaways  :  Health Insurance Tailored Plans

  • Freedom Health offers Special Needs Plans (SNPs) with services and benefits tailored for individuals with chronic diseases or dual Medicare/Medicaid eligibility.
  • Tailored health plans provide personalized coverage and customized benefits to meet your unique healthcare requirements.
  • Plans include Chronic Combined SNP, Chronic Pulmonary SNP, and Dual Eligible SNP to cater to specific health conditions and coverage needs.
  • Flexible plan options and bespoke healthcare solutions empower you to actively manage your well-being.
  • Specialized insurance solutions from Freedom Health are designed to support your individual health needs and goals.

Introduction to Tailored Health Plans

In the evolving landscape of healthcare, a new approach has emerged – tailored health plans. These specialized plans, a type of Special Needs Plan (SNP), offer personalized services and benefits designed to cater to the unique needs of individuals with specific chronic conditions or those who are dually eligible for both Medicare and Medicaid.

What Are Tailored Health Plans?

Tailored health plans are innovative solutions that provide targeted care and support for individuals with complex healthcare needs. These plans leverage a deeper understanding of the behavioral health, physical health, and socioeconomic factors that influence a person’s overall well-being. By addressing the unique challenges faced by Medicaid managed care and NC Medicaid managed care beneficiaries, these plans aim to deliver seamless, integrated care that improves outcomes and enhances the quality of life for tailored plan members.

Benefits of Personalized Coverage

The key advantages of tailored health plans include the ability to tailor care management for individuals with disabilities, traumatic brain injury, or substance use disorder. These plans also offer specialized behavioral health services and care management for those with mental health disorders. By leveraging innovation and a deep understanding of the NC Medicaid direct and Vaya Health systems, tailored plans provide a comprehensive approach to addressing the diverse needs of beneficiaries. This personalized coverage empowers members to actively manage their health, ultimately leading to improved outcomes and a better quality of life.

Health Insurance Tailored Plans

Freedom Health’s health insurance tailored plans are designed to provide personalized coverage and flexible, customized benefits to meet the unique healthcare needs of each individual member. These specialized insurance solutions offer a bespoke approach to healthcare, allowing members to access the care and services they require based on their specific health conditions and individual needs.

These tailored policies aim to empower members by offering a range of health insurance options that are personalized and flexible, ensuring they receive the customized benefits they need to manage their individual health needs effectively. The bespoke healthcare plans provided by Freedom Health are a testament to the company’s commitment to delivering specialized insurance solutions that cater to the unique requirements of each member.

health insurance tailored plans

By leveraging a healthcare customization approach, Freedom Health’s tailored health insurance plans enable members to access the precise care and support they need, ensuring they receive the most personalized coverage and flexible plans to address their individual health needs. This commitment to customized benefits and tailored policies sets Freedom Health apart as a leader in the health insurance options market, providing specialized insurance solutions that truly prioritize the well-being of each member.

Chronic Condition Special Needs Plans (C-SNPs)

Freedom Health offers Chronic Condition Special Needs Plans (C-SNPs) for members who have certain chronic diseases. These specialized plans are designed to provide personalized care and customized benefits to individuals living with chronic conditions, helping them better manage their health and improve their quality of life.

Qualifying Conditions for C-SNPs

The qualifying conditions for Freedom Health’s C-SNPs include:

  • Diabetes
  • Cardiovascular disease
  • Chronic/congestive heart failure
  • Chronic lung disorders, such as chronic obstructive pulmonary disease (COPD), chronic bronchitis, and asthma
  • Pulmonary fibrosis

Enrollment Process for C-SNPs

Individuals with one or more of the qualifying chronic conditions can enroll in a Freedom Health C-SNP during the designated enrollment periods. The enrollment process typically involves completing an assessment to determine the member’s specific healthcare needs and the appropriate level of care. This assessment helps the plan develop a personalized care plan to address the member’s condition and provide the necessary support and resources.

Once enrolled, C-SNP members have access to a range of benefits and services tailored to their chronic condition, including disease-specific education, care coordination, and access to specialized providers and treatments. The goal is to empower members to actively manage their health and improve their overall well-being.

Dual Eligible Special Needs Plans (D-SNPs)

Freedom Health also offers Dual Eligible Special Needs Plans (D-SNPs) for members who qualify for both Medicare and Medicaid benefits. These specialized plans are designed to cater to the unique needs of individuals who are eligible for both federal healthcare programs.

Eligibility Criteria for D-SNPs

To be eligible for a D-SNP, individuals must meet the criteria set by the Centers for Medicare and Medicaid Services (CMS). This includes being either a full dual eligible or a partial dual eligible beneficiary. Full dual eligibles are those who qualify for both full Medicare and full Medicaid benefits, while partial dual eligibles receive limited Medicaid assistance, such as help with Medicare premiums and cost-sharing.

Benefits of D-SNPs

D-SNPs offer a comprehensive suite of benefits tailored to the needs of dual eligible individuals. These plans typically provide coverage for a wide range of services, including Medicare-covered benefits, Medicaid-covered services, and additional supplemental benefits. This can include access to coordinated care, care management, and enhanced benefits that address the unique healthcare needs of this population.

dual eligible special needs plans

Tailored Plan Enrollment and Verification

After enrolling in a tailored health plan, members must complete several assessments to help the plan better understand their health status and needs. This process ensures that the plan can provide the most appropriate care and services to support the member’s well-being.

Initial Health Assessment

The first step in the tailored plan enrollment process is an initial health assessment. This comprehensive evaluation covers the member’s medical history, current health conditions, and any social determinants of health that may impact their overall well-being. The goal is to gather a holistic understanding of the member’s healthcare needs and establish a baseline for their care plan.

Disease-Specific Assessment

Once the initial health assessment is complete, the member will undergo a disease-specific assessment. This evaluation focuses on the member’s particular chronic condition or special needs, such as diabetes, cardiovascular disease, or chronic lung disorders. The plan uses this information to develop a targeted care plan that addresses the member’s specific healthcare requirements.

Determining Level of Care

Based on the findings from the initial health assessment and disease-specific assessment, the tailored plan will determine the appropriate level of care for the member. This risk stratification process assigns the member to one of three tiers: Tier 1 for members with minimal or stable healthcare needs, Tier 2 for those with moderate or complex needs, and Tier 3 for individuals with the most significant or complex healthcare requirements. The assigned tier will directly influence the member’s personalized care plan and the level of case management support they receive.

Case Management for Tailored Plans

The tailored health plans provided by Freedom Health offer comprehensive case management support to all members, with a particular focus on those individuals who are determined to need the most assistance, categorized as Tier 3 members. This specialized case management approach helps ensure that tailored plan participants receive the personalized care and resources they require to effectively manage their health conditions.

Role of Case Managers

Nurse case managers and social workers play a vital role in the case management of tailored plan members. These professionals work closely with participants to develop and implement individualized care plans that address their unique healthcare needs. They coordinate access to community resources, facilitate provider referrals, and provide ongoing support to help members navigate the complexities of the healthcare system.

Getting Enrolled in Case Management

Enrollment in the case management program is voluntary, and members can choose to participate or decline the service. During the initial health assessments, the plan’s care team will determine the appropriate level of case management needed for each member based on their specific health status and needs. Those identified as requiring the most comprehensive support (Tier 3) will be automatically enrolled in the case management program to ensure they receive the necessary provider referrals, community resources, and tailored interventions to achieve their health goals.

case management

Care Plans for Tailored Plan Members

All members enrolled in the tailored health plans have a customized care plan developed based on the information gathered from the health assessments and the member’s risk level. These personalized care plans ensure that each individual receives the appropriate level of support and services to manage their unique healthcare needs effectively.

Tier 1 Care Plans

Members classified as Tier 1 are generally in good health and have minimal healthcare needs. Their care plans focus on preventive care, health promotion, and early intervention to maintain their overall well-being. These plans may include regular check-ups, screenings, and educational resources to help members make informed decisions about their care plans, tailored plan members, tier 1 health.

Tier 2 Care Plans

Individuals in Tier 2 have more complex healthcare needs, often with care plans, tailored plan members, tier 2 one or more chronic conditions. Their care plans are designed to provide comprehensive case management, provider collaboration, and evidence-based interventions to help them better manage their health. These plans may include regular check-ups, medication management, and access to specialized services.

Tier 3 Care Plans

Members classified as Tier 3 have the highest level of healthcare needs and often require care plans, tailored plan members, tier 3 more intensive support. Their care plans focus on case management, provider collaboration, and a multidisciplinary approach to ensure they receive the necessary clinical practice guidelines, evidence-based medicine care and support to improve their overall health and quality of life.

Tier Member Profile Care Plan Focus
Tier 1 Generally healthy with minimal healthcare needs Preventive care, health promotion, early intervention
Tier 2 Complex healthcare needs, often with chronic conditions Comprehensive case management, provider collaboration, evidence-based interventions
Tier 3 Highest level of healthcare needs, require intensive support Case management, provider collaboration, multidisciplinary approach

Provider Education and Resources

At Freedom Health, we recognize the crucial role that healthcare providers play in delivering exceptional care to our members, particularly those enrolled in our Special Needs Plans (SNPs). To ensure our providers are well-equipped to address the unique needs of this population, we offer comprehensive SNP provider training and resources.

SNP Provider Training

Our SNP provider training program is designed to educate and empower all healthcare professionals, with a particular focus on primary care physicians (PCPs), who are responsible for managing the care of our chronic conditions and special needs plans members. This training covers a wide range of topics, including:

  • Understanding the specific needs and challenges faced by individuals with chronic conditions and disabilities
  • Implementing evidence-based medicine and clinical practice guidelines to deliver optimal care
  • Coordinating with our case management team to ensure seamless care transitions
  • Effectively utilizing available provider education and resources to support member health and well-being

Clinical Practice Guidelines

In addition to provider training, Freedom Health is committed to equipping our network of healthcare professionals with the latest clinical practice guidelines and evidence-based medicine resources. By staying up-to-date with the most current, evidence-based best practices, our providers can deliver the highest quality of care to our chronic conditions and special needs plans members, ensuring optimal health outcomes and improved quality of life.

provider education

Choosing the Right Tailored Plan

When selecting a tailored health plan, it’s important for individuals to carefully assess their unique healthcare needs and choose a plan that best fits their requirements. This involves evaluating factors such as chronic conditions, Medicare and Medicaid eligibility, and the personalized coverage and customized benefits offered by each plan.

Assessing Your Health Needs

The first step in choosing the right tailored plan is to assess your health needs. Consider any chronic conditions you may have, such as diabetes, cardiovascular disease, or chronic lung disorders. Determine if you are dual eligible, meaning you qualify for both Medicare and Medicaid benefits. Understanding your specific healthcare requirements will help you identify the plan that provides the most appropriate personalized coverage and customized benefits.

Comparing Plan Options

Once you have a clear understanding of your health needs, you can begin comparing plan options to find the tailored plan that best meets your requirements. Compare the services, benefits, and coverage offered by each plan, as well as any additional features or support programs that may be available. Carefully evaluate the plan’s network of providers, prescription drug coverage, and any limitations or exclusions that may apply.

By taking the time to assess your health needs and compare plan options, you can ensure that you choose the tailored health plan that will provide the personalized coverage and customized benefits you need to effectively manage your health and well-being.

Transitioning to a Tailored Plan

Transitioning to a tailored health plan can be a seamless process for individuals, whether they are enrolling in a tailored plan for the first time or switching from a different plan. Freedom Health’s specialized Medicare and Medicaid plans are designed to provide personalized coverage and customized benefits for those with chronic conditions or special needs.

Enrolling in a Tailored Plan

To enroll in a tailored plan, members can work closely with the plan’s enrollment team to ensure a smooth transition. This may involve completing an initial health assessment to determine the appropriate level of care and services required. The plan’s case managers will then collaborate with the member to develop a comprehensive care plan that addresses their unique healthcare needs.

Continuing Care with Existing Providers

One of the key advantages of transitioning to a tailored plan is the ability to continue care with existing healthcare providers. Freedom Health works to ensure a seamless transition, allowing members to maintain relationships with their trusted primary care physicians and specialists. This helps minimize disruptions to their ongoing treatment plans and supports a smooth continuum of care.

The NC Medicaid Ombudsman assists with plan enrollment for North Carolina’s Medicaid program. People will be automatically enrolled in a tailored plan, where they will be assigned a primary care provider. The North Carolina Department of Health and Human Services oversees these services, which include care coordination through a care manager.

Enrolled in the tailored plan, individuals will receive services for mental health that are not available in standard plans. North Carolina’s local department of social services can provide information on the various plans in North Carolina, including standard health care organizations and tailored plans. For assistance, contact the NC Medicaid enrollment broker call center, available Monday through Saturday from 7 a.m. to 5 p.m. If you call outside these hours, please leave a message.

This one health plan aims to support a person’s health, including serious mental health services. You can also reach out via phone number and email address provided by the tailored plan’s network for additional support.

Transitioning to tailored plan

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Freedom Health’s tailored health insurance plans offer a personalized and flexible approach to healthcare, providing customized benefits and services to meet the unique needs of each individual member. Whether it’s a Chronic Condition Special Needs Plan (C-SNP) or a Dual Eligible Special Needs Plan (D-SNP), these specialized insurance solutions are designed to empower members to actively manage their health and access the care they require.

By leveraging evidence-based practices, comprehensive assessments, and personalized care plans, the tailored plans ensure that members receive the bespoke healthcare solutions they need to live their healthiest lives. These flexible plans and customized benefits cater to the individual health needs of each member, offering a truly personalized coverage experience.

Freedom Health’s tailored policies and health insurance options provide a unique opportunity for individuals to access the healthcare customization they deserve, empowering them to take control of their well-being and thrive in their communities.


Q: How do I enroll in a tailored health insurance plan?

A: You can enroll in a tailored health insurance plan through the North Carolina Medicaid program or by contacting the NC Medicaid enrollment broker.

Q: What services do tailored health plans cover?

A: Tailored health plans cover a range of services including behavioral health management, substance use disorder treatment, and primary care services.

Q: What is the role of a care manager in tailored health plans?

A: A care manager in tailored health plans helps coordinate healthcare services, coordinates with healthcare providers, and supports individuals in managing their health needs.

Q: How do I contact the NC Medicaid Ombudsman?

A: You can contact the NC Medicaid Ombudsman for assistance with any issues or concerns related to your tailored health insurance plan.

Q: When will the move to tailored health plans for Medicaid beneficiaries take place?

A: The move to tailored health plans for Medicaid beneficiaries is scheduled to take place on July 1, 2024.

Q: Which organizations offer tailored health plans in North Carolina?

A: Tailored health plans are offered by various organizations such as Alliance Health, Vaya Health, and other Medicaid managed care companies in North Carolina.

Q: What are the benefits of enrolling in a tailored health plan?

A: Enrolling in a tailored health plan provides individuals with access to specialized healthcare services tailored to their specific needs, ensuring comprehensive and personalized care.

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