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, 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 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), and certain neurologic disorders
- Institutional SNPs (I-SNPs): For individuals who live in an institution, such as a nursing home, long-term care skilled nursing facility (LTC SNF), intermediate care facility, or assisted living facility
- Dual Eligible SNPs (D-SNPs): For individuals enrolled in Medicare and Medicaid (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 premium, 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 coverage.
You can enroll in a SNP if you have ESRD if the plan specifically serves individuals with ESRD.
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 providers to receive coverage, or have the option of going out of network.
SNPs are not available everywhere. Call 1-800-MEDICARE 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.