Medicare Special Needs Plans (SNPs) are private companies that the federal government pays to administer Medicare benefits. Like all Medicare Advantage Plans, SNPs must provide you with the same benefits, rights, and protections as Original Medicare Original Medicare, also known as Traditional Medicare, is the fee-for-service health insurance program offered through the federal government, which pays providers directly for the services you receive. Almost all doctors and hospitals in the U.S. accept Original Medicare. , but they may do so with different rules, restrictions, and costs. Some SNPs offer additional benefits, such as vision and hearing care.
Eligibility and costs basics
All SNPs are designed to meet specific care needs, and you can only join a SNP if you fit the special needs category the plan serves. SNPs may provide care and coverage coordination services not offered by other types of Medicare Advantage Medicare Advantage, also known as Part C, Medicare Private Health Plan, or Medicare Managed Care Plan, allows you to get Medicare coverage from a private health plan that contracts with the federal government. All Medicare Advantage Plans must offer at least the same benefits as Original Medicare (Part A and Part B), but can do so with different rules, costs, and coverage restrictions. Plans typically offer Part D drug coverage as part of Medicare Advantage benefits. Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), Private Fee-for-Service (PFFS) plans, Special Needs Plans (SNPs), and Medicare Medical Savings Accounts (MSAs). Plan. There are three types of SNPs:
- Chronic Condition SNPs (C-SNPs): For individuals with specific chronic conditions, such as cancer, dementia, diabetes, HIV/AIDS, stroke, End-Stage Renal Disease (ESRD) End-Stage Renal Disease (ESRD) is a kidney disease that requires you to be on dialysis or have a kidney transplant. Patients with ESRD may qualify for Medicare coverage regardless of age. , and certain neurologic disorders
- Institutional SNPs (I-SNPs): For individuals who live in an institution, such as a nursing home A nursing home, also called a long-term care facility, is a residential facility for people with chronic illness or disability. Nursing home services include room and board, nursing care, personal care, and therapy services. A skilled nursing facility (SNF) is a nursing home that provides skilled care, but not all nursing homes are SNFs. Medicare does not cover the cost of nursing homes that are not SNFs. , long-term care skilled nursing facility (LTC SNF), intermediate care facility, or assisted living facility Assisted living facilities are long-term care facilities designed to assist people with activities of daily living who can otherwise take care of themselves. They are different from nursing homes, which also provide skilled care. Medicare does not cover room and board in an assisted living facility.
- Dual-Eligible SNPs (D-SNPs): For individuals enrolled in Medicare and Medicaid Medicaid is a federal and state program that provides health coverage for certain people with limited income and assets. (dually eligible individuals)
You must have both Parts A and B to join a SNP, and generally you will continue paying your Medicare Part B Part B, also known as medical insurance, is the part of Medicare that covers most medically necessary doctors’ services, preventive care, hospital outpatient care, durable medical equipment (DME), laboratory tests, x-rays, mental health services, and some home health care and ambulance services. , though some SNPs will pay part of this premium. Some SNPs will charge an additional premium, on top of your Part B premium. You may be eligible for other forms of premium assistance if you are eligible for a SNP. SNPs are also required to provide Part D Part D, also known as the Medicare prescription drug benefit, is the part of Medicare that provides prescription drug coverage. Part D is offered through private companies either as a stand-alone plan, for those enrolled in Original Medicare, or as a set of benefits included with a Medicare Advantage Plan. coverage.
Benefits access basics
Your Medicare SNP may be a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO). Depending on your plan, you may need to see in-network In-network means part of a private health plan’s network of providers. If you use doctors, hospitals, pharmacies, home health agencies, skilled nursing facilities, and durable medical equipment suppliers that are in your Medicare Advantage Plan or Part D plan’s network, you will generally pay less than if you go to out-of-network providers. providers to receive coverage, or have the option of going out of network.
SNPs are not available everywhere. Call 1-800-MEDICARE (633-4227) or your State Health Insurance Assistance Program (SHIP) to find out if there is a SNP available in your area. To enroll in a SNP, call Medicare or the plan directly. Be sure to make an informed decision by contacting a plan representative to ask questions before enrolling.