How Medicare Advantage Works With Special Needs Plans

iQuanti: When you become eligible for Medicare, you have options for how to receive your benefits. You can enroll in Original Medicare Part A and Part B, join a Part C Medicare Advantage plan, purchase a Medicare Supplement (Medigap) plan, and/or get prescription drug coverage from a Part D plan.
Not only that, but there are different types of plans. For example, types of Medicare Advantage plans include health maintenance organization (HMO), preferred provider organization (PPO), private fee-for-service (PFFS) plans, and special needs plans (SNP).
Depending on your circumstances, an SNP may be your best option. Here is more information about what an SNP is, who qualifies, what is covered by these plans, and how much they cost, to help you determine what’s right for you.
What is a Special Needs Plan?
A Medicare SNP is a type of Medicare Advantage plan, but they limit membership to people with specific diseases or characteristics. These plans tailor their benefits, provider network, and prescription drug coverage specifically for those they serve. They are intentionally designed for providing focused and coordinated care to a specialized population.
If you fall into a qualifying category, you may have unique healthcare needs that an SNP plan can help address, such as needing a larger network of specialized providers, or drug formularies tailored to cover prescriptions you may be prescribed.
SNPs are offered by private insurance companies, like other Medicare Advantage plans, and must be approved by Medicare. Other than emergency or urgent care, you typically have to get all of your care and services from a doctor or hospital in the SNP network.
Who qualifies for an SNP?
You can join a Medicare SNP if:
As long as you continue to meet the conditions and requirements of the plan, you can stay enrolled. If you lose eligibility for the plan, you’ll have a special enrollment period to decide what other way you want to receive Medicare benefits.
What is covered by an SNP?
Medicare SNPs must cover all of the services and supplies that Original Medicare does.
Additionally, they may cover extra services tailored specifically for the group or condition they serve. To know exactly what benefits and services the plan covers, check the specific plan directly.
How much does an SNP cost?
If you are dual-eligible, meaning you have both Medicare and Medicaid, most costs of an SNP are covered for you.
Otherwise, your exact costs may vary depending on the plan you choose. These costs usually are similar to costs of other Medicare Advantage plans, and may include:
You usually must also pay your Medicare Part B monthly premium.
You’ll likely pay less if you see in-network providers for your care. Another cost-saving benefit is that many Medicare Advantage plans limit your out-of-pocket costs with a maximum annual out-of-pocket amount, so you’ll never pay more than that for care and can budget appropriately.
Source: iQuanti, Inc.