Questions to ask before enrolling in a SNP

When you are considering a Medicare Special Needs Plan (SNP) Special Needs Plan (SNP) Special Needs Plans (SNPs) are Medicare Advantage Plans designed to meet specific care needs. You can only join a SNP if you fit the special needs category the plan serves. A SNP may serve people who have both Medicare and Medicaid (dual-eligibles); people who have specific chronic conditions, like diabetes; or people who live in an institution, such as a long-term care facility. , here are some questions to keep in mind. You should also review general questions to consider before joining a Medicare Advantage 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.

• Am I eligible for any of the SNPs in my area?
• How do the SNP’s services compare with those available through my current plan or other plans in my area?
• What benefits does the SNP provide that will help with my special needs?
  • Chronic Condition SNP (C-SNP): What special services does the plan offer to help manage my condition? Does it cover specialists that I need to see?
  • Institutional SNP (I-SNP): Will the plan improve my care or experience in the nursing home 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. ? Will I have regular access to a nurse practitioner or other providers I need?
  • Dual Eligible SNP (D-SNP): Does the plan coordinate my Medicare and Medicaid Medicaid Medicaid is a federal and state program that provides health coverage for certain people with limited income and assets. benefits to make them easily accessible?
• What costs should I expect for my coverage (premiums, deductibles, copayments)?
• Is there an annual limit on my out-of-pocket expenses?
• Will I be able to use my doctors? Are they in the plan’s network?
  • If I join an Institutional SNP, will the plan’s network network A network is a group of doctors, hospitals, and pharmacies that contract with a Medicare Advantage Plan to provide health care services. Generally, plan members will have the lowest costs when using providers and facilities in the plan’s network. Networks may be made up of both preferred and non-preferred providers. include my nursing home or home care provider?
• Are the plan’s in-network 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 and facilities in convenient locations?
• Does the plan provide coverage for services I receive from out-of-network out-of-network Out-of-network means not part of a private health plan’s network of health care providers. If you use doctors, hospitals, or pharmacies that are not in your Medicare Advantage Plan or Part D plan’s network, you will likely have to pay the full cost out of pocket for the services you received. providers?
• Do I need a referral referral Referrals are authorizations that Medicare Advantage Plans usually require for services not provided by your primary care provider (PCP). For example, Health Maintenance Organizations (HMOs) generally require you to get a referral from your PCP in order to see a specialist or get an eye exam. to see a specialist specialist A specialist is a doctor who specializes in treating only a certain part of the body or a certain condition. For instance, a cardiologist only treats people with heart problems. ?
• Are my drugs on the plan’s formulary formulary The formulary is the list of prescription drugs covered by a Part D plan or Medicare Advantage Plan. If your drug is not on the formulary, you may have to request an exception, file an appeal, or pay out of pocket. ?
• What special accommodations does the SNP make for persons with disabilities?
• What special language and cultural accommodations does the SNP make?

Call 1-800-MEDICARE (1-800-633-4227) 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.