Medicare Special Needs Plans (SNPs) must provide you with the same benefits as Original Medicare but may do so with different rules, restrictions, and costs. SNPs can also offer additional benefits. Below is a list of general cost and coverage rules for Medicare SNPs. Remember to speak to a plan representative to learn the details about any plan you are considering.
Costs
- Plans may charge a monthly in addition to the 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. premium.
- Plans may set their own deductibles, copayments, and other
cost-sharing
Cost-sharing is the portion of medical care costs that you pay yourself, such as a copayment, coinsurance, or deductible, if you have health insurance coverage. See also: Out-of-Pocket Costs.
for services.
- If you have Medicaid, you should not pay Medicare deductibles and copays while seeing providers in your Dual Eligible SNP’s (D-SNP’s) 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. .
Providers
- Plans may help manage your care by providing:
- Access to a care manager A care manager is a nurse, specially trained educator, or doctor who will assess your needs and advise you on how to best manage your health conditions. who will assess your needs and provide supervision
- Coordination of your Medicare and Medicaid Medicaid is a federal and state program that provides health coverage for certain people with limited income and assets. Â benefits, if you are enrolled in a D-SNP
- Depending on your plan, you may have coverage for out-of-network care. However, you may pay a higher amount for out-of-network services. Check with your plan before seeing an out-of-network provider.
- SNPs cannot charge more than 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. charges for certain kinds of care, including chemotherapy, dialysis Dialysis is the treatment used to artificially cleanse your blood of toxins when your kidneys no longer work. , and skilled nursing facility (SNF) Skilled nursing facilities (SNFs) are Medicare-approved facilities that provide short-term post-hospital extended care services. care. However, SNPs can charge higher copays for other services, including home health, durable medical equipment (DME) Durable medical equipment (DME), also known as DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics, and Supplies) is equipment that primarily serves a medical purpose, is able to withstand repeated use, and is appropriate for use in the home; for example, wheelchairs, oxygen equipment, and hospital beds. Medicare only covers DME if your provider says it is medically necessary for use in the home. , and inpatient An inpatient is a patient who has been formally admitted into the hospital by a doctor. Most inpatient care is covered under Medicare Part A (hospital insurance). hospital care.
Benefits
- All SNPs are required to provide Part D coverage.
- Your SNP may offer additional benefits, such as vision, hearing, or dental care. Check with the plan directly to learn about coverage rules and restrictions for any added benefits.