Medicare Special Needs Plans

You can join an SNP if you meet these requirements:

• You have Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance).
• You live in the plan's service area. 
• You meet the eligibility requirements for one of the 3 types of SNPs:
  1. Dual Eligible SNP (D-SNP)
  2. Chronic Condition SNP (C-SNP)
  3. Institutional SNP (I-SNP)

Costs vary by plan. Some may charge a premium on top of the monthly Part B premium. If you have both Medicare and Medicaid, most costs are usually covered. Contact your Medicaid office for details.

Yes. All SNPs must provide Medicare drug coverage (Part D).

Coverage varies by plan. Some SNPs require you to use in-network providers and facilities (except for emergencies, urgent care outside the area, or out-of-area dialysis). Other SNPs allow out-of-network care, but at a higher cost.

• D-SNPs coordinate benefits between Medicare and Medicaid.
• For I-SNPs, check that your facility has participating providers.
• C-SNPs may limit membership to specific chronic conditions.
• All SNPs provide a care coordinator to help manage your health and care plan.
• You can stay enrolled in an SNP only if you meet the plan’s specific condition.
• If you lose coverage due to no longer meeting plan conditions, you may qualify for a Special Enrollment Period.
• SNPs can’t charge more than Original Medicare for services like chemotherapy, dialysis, or skilled nursing.
• Approved treatments remain valid as long as medically necessary, without needing new approvals. If switching plans, you have a 90-day grace period for existing approvals.
• Contact the plan directly for specific details