Special Needs Plans (SNPs) offer a focused approach to healthcare, catering to individuals with specific medical conditions, unique healthcare requirements, or those who are also beneficiaries of Medicaid. SNPs meticulously customize their benefits, provider selections, and covered drug lists (formularies) to precisely address the needs of the particular groups they serve.
SNPs can fall under Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) categories, providing coverage for the same Medicare Part A and Part B benefits as other Medicare Advantage Plans. However, SNPs often extend additional services to cater to their specialized groups. For instance, if you have a severe medical condition like cancer or congestive heart failure requiring a hospital stay, an SNP might cover extended days in the hospital. Continuous eligibility for an SNP hinges on maintaining the specific criteria stipulated by the plan.
You’re eligible to enroll in an SNP if you fulfill these prerequisites:
Each year, different varieties of SNPs may be accessible in different geographical regions across the country. Insurance companies determine their operational areas, hence SNPs may not be universally available throughout the U.S.
The premium structure varies based on the plan. Some may entail a premium alongside the monthly Part B (Medical Insurance) premium. However, if you hold both Medicare and Medicaid, the majority of costs are typically covered. For detailed information, contact your Medicaid office.
Yes, all SNPs must include Medicare drug coverage (Part D).
The protocol depends on the specific plan.
The requirement varies among plans. If you have a preferred primary care doctor or provider, inquire if you can retain their services under the chosen plan.
Referral criteria fluctuate according to the plan. Certain services might necessitate referrals while others may not.