Medicare Advantage Special Needs Plan

Medicare Advantage Special Needs Plans (SNPs)

These Medicare Advantage Plans are designed specifically for people with chronic conditions or special health needs. The benefits, providers and prescription drug formularies are carefully chosen for these unique needs.

If you are eligible, you can join a Special Needs Plan at any time.

Are you eligible for a Special Needs Plan?

To enroll in a Medicare Special Needs Plan, you must be enrolled in Medicare Parts A and B as well as live in the Plan’s service area.

Here are the three kinds of Special Needs Plans:

• Chronic-Condition Special Needs Plans (C-SNP) are for people with certain severe or disabling chronic conditions, such as cancer, heart disease, diabetes or dementia.
• Institutional Special Needs Plans (I-SNP) serve those living in a health care facility (such as a nursing home) or who need health care at home.
• Dual-Eligible Special Needs Plans (D-SNP) are an option for people who have both Medicare and Medicaid benefits (also called “dual eligibles”).

Where do you go for your health care?

Most of the time, you must get your care and from doctors, specialists and hospitals in the Medicare SNP network, unless you need:

• Emergency or urgent care, or
• Immediate dialysis for End-Stage Renal Disease (ESRD).

Are prescription drugs covered?

Yes, all SNPs must provide prescription drug coverage.

Do you need to choose a primary care provider?

In most cases, you will have a primary care provider. Or, you may have a care coordinator to help with your health care. Your doctor or coordinator will refer you to see a specialist if needed.

What kinds of health care benefits do SNPs offer?

Medicare Advantage Special Needs Plans include coverage for:

• hospital services (Medicare Part A)
• medical services (Medicare Part B)
• prescription drugs (Medicare Part D)
• specific benefits and programs for your condition

You can find Special Needs Plans through private health insurance companies approved by Medicare.

What are your costs for a Special Needs Plan?

Costs vary due to a lot of different things. Here is an overview of costs:

• Your Part B premium
• Your SNP monthly premium
• Possibly an extra monthly premium for your prescription drug coverage or additional benefits
• Copays, coinsurance and deductibles

Be sure to review your materials and talk to the private health insurance company you choose. This way you will know exactly which costs apply to the SNP plan you have chosen.

Do you have questions?

Call 1-800-MEDICARE (TTY users 1-877-486-2048), 24 hours a day, seven days a week. If you have both Medicare and Medicaid benefits, contact your state’s Medicaid office also.