If you are thinking about joining a Special Needs Plan (SNP), find out:

  • How does the SNP’s services compare with those available directly through Original Medicare (and Medicaid, if you qualify) and to other Medicare Advantage Plans in your area?
  • Are your special needs included in the groups the plan serves? Examples of Special Needs Plans include plans for people with HIV/AIDS, diabetes or people who have both Medicare and Medicaid.
  • What extra benefits does the SNP provide that will help with your special needs and manage your care?
    • For example, if the SNP focuses on a chronic condition (such as cardiovascular disease, congestive heart failure or diabetes), what special services does the plan offer that will help you manage that condition? Does it cover doctors who are specialists that you need to see?
    • If you enroll in an institutional SNP, will it improve the care you get in the nursing home (for example, will you have regular access to a nurse practitioner?)
  • If you have both Medicare and Medicaid:
    • Does the plan offer special coordination services to help you access your Medicaid benefits (such as transportation and long-term care services) with ease?
    • Are plan providers aware that they should not usually charge you Medicare copays?
  • Are the providers (doctors and hospitals) you currently use covered by the plan (in its network)?
    • If you are joining an institutional SNP, does its network include your nursing home or home care provider (if you live in the community)?
  • Will it be easy for you to get to providers (are they located near you)?
  • What is the monthly premium (if you are enrolled in low income programs, such as Extra Help and Medicaid, how much of the premium will you owe?)
  • Is there a deductible that you must pay before the plan starts paying for your health care expenses?
  • How much would you pay to see in-network doctors?
  • Will the plan cover you if you see out-of-network doctors?
  • Would you have to get a referral to see specialists?
  • What is the annual limit on how much you can spend out of pocket?
  • Are the drugs you take on the plan’s list of covered drugs (formulary)? If so, do any restrictions apply?
  • What special accommodations does the SNP make for persons with disabilities?
  • What special language and cultural accommodations does the SNP make?

You should call the plan to find out exactly what services it offers. You can call 1-800-MEDICARE or go to Medicare’s web site (Medicare.gov) to find out if there are SNPs available in your area These sources will not be able to tell you everything about a SNP’s benefits (for example, if the plan’s doctors take Medicaid). You should double check all information with the plans directly. Keep a record of what you were told and the name of the person who gave you the information. If you join the plan and later learn the information was incorrect, you may be able to get a Special Enrollment Period to change plans or go back to Original Medicare.