Medicare Corner
Understanding Special Needs Plans (SNP) What's a SNP? A Special Needs Plan (SNP) provides benefits and services to people with specific severe and chronic diseases, certain health care needs, or also have Medicaid. They include care coordination services and tailor their benefits, provider choices, and list of covered drugs (formularies) to best meet the specific needs of the groups they serve. SNPs are either HMO or PPO plan types and cover the same Medicare Part A and Part B benefits that all Medicare Advantage Plans cover. However, SNPs might also cover extra services for the special groups they serve. For example, if you have a severe condition such as congestive heart failure and you need a hospital stay, a SNP may cover extra days in the hospital. You can only stay enrolled in a SNP if you continue to meet the special conditions of the plan. Who can join a SNP? You can join a SNP if you meet these requirements: • You have Medicare Part A and Medicare Part B • You live in the plan's service area • You meet the eligibility requirements for one of the 3 types of SNPs: 1. Dual Eligible SNP (D-SNP) 2. Chronic Condition SNP (C-SNP) 3. Institutional SNP (I-SNP)
What else do I need to know? • D-SNPs can help coordinate your benefits between Medicare and Medicaid. • If you’re interested in an I-SNP, and live in a facility, check that the plan has providers that serve people where you live. • C-SNPs can limit membership to a single chronic condition or a group of related chronic conditions. • All SNPs use a care coordinator to help you stay healthy and develop a care plan with you. • You can stay enrolled in a Medicare SNP only if you continue to meet the condition served by the plan. If you're losing your plan because you no longer meet the plan's conditions, you may be eligible for a Special Enrollment Period to join another plan. • Your plan can’t charge more than Original Medicare for certain services like chemotherapy, dialysis, and skilled nursing facility care. • If your plan gives you prior approval for a treatment, the approval must be valid for as long as the treatment is medically necessary. Also, your plan can’t ask you to get additional approvals for that treatment. If you’re currently getting treatment and you switch to a new plan, you’ll have at least 90 days before the new plan can ask you to get a new prior approval for your ongoing treatment. • Check with the plan you’re interested in for specific information.
Q: Do these plans charge a monthly premium? A: Varies by plan. Some plans may charge a premium, in addition to the monthly Part B (Medical Insurance) premium. However, if you have Medicare and Medicaid, most of the costs will be covered for you. Q: Do these plans offer Medicare drug coverage (Part D)? A: Yes. All SNPs must provide Medicare drug coverage (Part D). Q: Can I use any doctor or hospital that accepts Medicare for covered services? A: Varies by plan: • Some SNPs require that you receive your care and services from providers and facilities in the plan’s network (except for emergency care, out-of-area urgent care, or out-of-area dialysis). • Some SNPs offer out-of-network coverage, so you can get services from any qualified provider or facility, but you’ll usually pay more. Q: Do I need to choose a primary care doctor? A: Varies by plan. If you have a primary care doctor or provider you like, ask the plan if you can keep them. Q: Do I have to get a referral to see a specialist? A: Varies by plan. Referrals may be required for certain services but not others.
May & June 2025, Never Too Late | Page 11
Pima Council on Aging
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