Like all Medicare Advantage plans (private health plans), each Special Needs Plan (SNP) offers different services and has different costs. All SNPs must offer Medicare drug coverage (Part D) as part of their benefits packages. However, each plan will have a different formulary (list of covered drugs) and work at different drug stores (pharmacy network).

Most SNPs generally only cover visits to doctors and hospitals in the plan’s network. You may have to pay in full to see any providers that are out of network. Remember that Medicare Advantage plans will work differently than Original Medicare. Original Medicare will cover you to go to any hospital and see any doctor that accepts Medicare payments.  If you have both Medicare and Medicaid, SNP providers cannot charge you Medicare deductibles or copays.

All SNPs should provide services to help manage your care. However, these services can vary greatly from one SNP to another. Unique services from a SNP may include: 

• regular access to a care manager, a nurse or specially trained educator or doctor who will assess your needs and advise you on how to best manage your health conditions.
• coordination of your Medicare and Medicaid coverage if you are in a dual eligible SNP. People who have both Medicare and Medicaid are often called dual eligibles.
  • For example, dual eligible SNP providers cannot charge you for Medicare copays.  Also, the SNP might offer you easier access to Medicaid-covered services (like transportation and personal care).

Before joining any SNP, you should call the plan to find out what services it offers and how it works.

 To find out more about Original Medicare, private health plans, and how to decide how to get your Medicare benefits, click on the link in the GO TO box.

For a list of questions you should ask before joining a SNP, click on the link in the GO TO box.