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Health Care Reform:

Health Insurance & Affordable Care Act

Chronic Conditions & Medicare: Special Needs Plan (SNP)

Chronic Conditions SNPs Apply To

If you have cancer or heart disease, you could get an SNP. Those are among the 15 chronic conditions that SNPs cover. Other examples are autoimmune disorders, diabetes, dementia, lung disease, and end-stage liver and kidney diseases. An SNP may focus on one chronic condition or several. 

For a full list of conditions, go to Medicare.gov. Click on "Can I join an SNP?"

What a Medicare SNP Costs

Your out-of-pocket costs will depend on how often you need care and the type of care you need. Whether you use doctors who are in your SNP's network or out of the network also will make a difference. You should know that:

  • Your costs probably will include your Medicare Part B premium plus any deductibles, coinsurance, or copays that your SNP charges.
  • In some plans, you also pay an SNP premium.
  • If you can get both Medicare and Medicaid, or if you have a limited income, you'll be able to get care without spending as much money.

Before you join an SNP, ask what you will be expected to pay.

How to Sign Up for a Medicare SNP

First, find an SNP in your area.

  • Call 800-MEDICARE (800-633-4227).
  • Go online to the Medicare Plan Finder web site: www.medicare.gov/find-a-plan.
  • Contact your local State Health Insurance Assistance Program. (Scroll to SHIP under "choose organization.") People there can help you sign up for a Medicare SNP.

Then, fill out an application form. You can ask the SNP to send you a form. Some SNPs will let you sign up through their web site. Or if you have Medicare and Medicaid, you may be able to sign up at Medicare.gov. For more help, call 800-MEDICARE.

When to Enroll in an SNP

If you are joining Medicare for the first time: You can sign up during your first Medicare enrollment period. That is usually the month you turn 65 and the 3 months before and after that month.

If you already have Medicare: You can join during the next open enrollment period.

If you develop a severe disability and enter a nursing home: You can join at any time.

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