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Health Care Reform:

Health Insurance & Affordable Care Act

Back to ACA Health Insurance Terms List

Special needs plan (SNP)

Special needs plans are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics. Then they tailor benefits, provider choices, and drug formularies (list of covered drugs) to best meet the specific needs of the groups they serve.

SNPs are approved by Medicare and run by private companies. When you join a SNP, you get all your Medicare hospital, medical health care services, and prescription drug coverage through that plan.

You can join a SNP if you have both Medicare Part A and Part B, live in the plan's service area, and meet the plan's eligibility requirements. Those requirements include having certain chronic conditions (such as dementia, cancer, and stroke, among many others), living in an institution (such as a nursing home), or receiving both Medicare and Medicaid (dual eligible).

If you join a SNP, you still have all the rights of Medicare coverage, but you will have to follow the rules of the private insurance plan. For instance, to keep costs down, you may need to use doctors in the plan's network. You may also need to get a referral from your primary doctor before seeing a specialist.


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