Joining a Medicare SNP is your choice if you qualify.
Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage Plan (like an HMO or PPO) that limits membership to people with specific chronic diseases and conditions or who have specialized needs (such as people who have both Medicare and Medicaid or people who live in certain institutions). They tailor their benefits, provider choices, and drug formularies (list of covered drugs) to best meet the specific needs of the groups they serve.
Who Can Join a Medicare SNP? You can join a Medicare SNP if you have Medicare Part A and Part B, live in the plan's service area, and meet the plan's eligibility requirements, such as one of the following:
- You have one or more specific chronic or disabling conditions (like diabetes, congestive heart failure, or C.O.P.D)
- You live in an institution (like a nursing home), or you require nursing care at home.
- You have both Medicare and Medicaid.
Just like other Medicare health plans, if you join a Medicare SNP, you will have to see providers who belong to the plan, or use certain hospitals to get covered services. In most cases, you will need referrals to see specialists. The Medicare SNP will still cover emergency or urgently needed care, even if you're out of the plan's service area.
If you have Medicare and Medicaid, the costs of joining a Medicare SNP may be covered for you. Contact your State Medical Assistance (Medicaid) office for more information and to see if you qualify for Medicaid benefits. Visit www.medicare.gov, or call 1-800-MEDICARE (1-800-633-4227) to get the phone number for your local Medicaid office - TTY users should call 1-877-486-2048.