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Health Care Reform:

Health Insurance & Affordable Care Act

Chronic Conditions & Medicare: Special Needs Plan (SNP)

If you have a chronic condition, you may be able to get a special Medicare plan called a special needs plan (SNP). It's a type of Medicare Advantage Plan that is limited to people with certain diseases or conditions. A Medicare SNP provides coverage for hospital stays, office visits, prescription drugs, and all other Medicare-covered services.

To join a Medicare SNP, you must have Medicare Part A and Part B. You also must live in the plan's service area. Then, you may be eligible if at least one of these is true for you:

  • You have one or more severe or disabling chronic conditions.
  • You live in a nursing home or need nursing care at home.
  • You have Medicare and Medicaid.

Benefits of a Medicare SNP

A Medicare SNP combines hospital, medical, and prescription drug benefits. That makes it easier to coordinate all the parts of your care, makes it easier to follow your doctor’s advice for diet and prescriptions, and can help you get help from the community. All of your medical services are provided through a single plan.

Once you are enrolled in a plan, before you receive a service, it is important to make sure the SNP plan covers the services you need. If you are not sure, you can ask the plan for a decision in advance to make sure the service is covered.

A Medicare SNP is designed just for you. An SNP tailors your benefits, doctors, and drug coverage to meet your specific needs. For instance, say you have congestive heart failure. Your SNP might offer special programs to manage care for people with congestive heart failure. It also might help you find doctors who specialize in treating it.

You also may have a care coordinator. This person makes sure you get the preventive care and treatments you need to stay as healthy as possible. Your care coordinator can connect you with helpful community services.

If you have Medicare and Medicaid, a Medicare SNP can help coordinate them.

You won't need extra drug coverage. Medicare SNPs include drug coverage. That means you do not need Part D, Medicare's prescription drug plan.

You may not need other insurance. When you join a Medicare SNP, you can keep your Medicare supplemental insurance. That insurance is also called a Medigap policy. But you might not need the extra coverage. Medicare SNPs often cover additional services, like extra days in the hospital. It is important to review the benefits of both plans to make sure you are not paying for supplemental insurance you do not need.

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