Special Needs Plans (SNP)

How Medicare SNPs work

Medicare SNPs are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve. Find out who can join a Medicare SNP.

Can I get my health care from any doctor, other health care provider, or hospital?

Some SNPs cover services out of network and some don’t. Check with the
plan to see if they cover services out of network, and if so, how it affects
your costs.

Medicare SNPs typically have specialists in the diseases or conditions that affect their members.

Are prescription drugs covered? 

All SNPs must provide Medicare drug coverage (Part D).

Do I need to choose a primary care doctor? 

Generally, yes. In most cases, SNPs may require you to have a primary care doctor. Or, the plan may require you to have a care coordinator to help with your health care.

Do I have to get a referral to see a specialist?

In most cases, you have to get a referral to see a specialist in SNPs. Certain services don't require a referral, like these:

  • Yearly screening mammograms
  • An in-network pap test and pelvic exam (covered at least every other year)

What else do I need to know about this type of plan?

  • These groups are eligible to enroll in an SNP: 1) people who live in certain institutions (like nursing homes) or who live in the community but require nursing care at home, or 2) people who are eligible for both Medicare and Medicaid, or 3) people who have specific chronic or disabling conditions (like diabetes, End-Stage Renal Disease (ESRD), HIV/AIDS, chronic heart failure, or dementia). Plans may further limit membership to a single chronic condition or a group of related chronic conditions. You can join a SNP at any time.

  • An SNP provides benefits targeted to its members’ special needs, including care coordination services.
  • If you have Medicare and  Medicaid [Glossary] , your plan should make sure that all of the plan doctors or other health care providers you use accept Medicaid.
  • If you live in an institution, make sure that plan providers serve people where you live. Find out more about where SNPs are offered.
  • Check with your plan for more information.

Find out who to call about Medicare options, claims and more.