Special Needs Plans (SNP)
What's an SNP?
A Special Needs Plan (SNP) provides benefits and services to people with specific diseases, certain health care needs, or who also have Medicaid. SNPs tailor their benefits, provider choices, and list of covered drugs (formularies) to best meet the specific needs of the groups they serve.
SNPs are either HMO or PPO plan types, and cover the same Medicare Part A and Part B benefits that all Medicare Advantage Plans cover. However, SNPs might also cover extra services for the special groups they serve. For example, if you have a severe condition, like cancer or congestive heart failure, and you need a hospital stay, an SNP may cover extra days in the hospital. You can only stay enrolled in an SNP if you continue to meet the special conditions of the plan.
Who can join an SNP?
You can join an SNP if you meet these requirements:
- You have Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) .
- You live in the plan's service area .
- You meet the eligibility requirements for one of the 3 types of SNPs:
- Dual Eligible SNP (D-SNP)
- Chronic Condition SNP (C-SNP)
- Institutional SNP (I-SNP)
Where are SNPs offered?
Each year, different types of SNPs may be available in different parts of the country. Insurance companies decide where they’ll do business, so SNPs may not be everywhere in the U.S.
Questions you may have about SNPs:
Do these plans charge a monthly premium ?
|Varies by plan. Some plans may charge a premium, in addition to the monthly Part B (Medical Insurance) premium. However, if you have Medicare and Medicaid, most of the costs will be covered for you. Contact your Medicaid office for more information.|
|Do these plans offer Medicare drug coverage (Part D)?||Yes. All SNPs must provide Medicare drug coverage (Part D).|
|Can I use any doctor or hospital that accepts Medicare for covered services?||
Varies by plan.
|Do I need to choose a primary care doctor ?||Varies by plan. If you have primary care doctor or provider you like, ask the plan if you can keep them.|
|Do I have to get a referral to see a specialist?||Varies by plan. Referrals may be required for certain services but not others.|
|What else do I need to know?||