Special Needs Plans

Special Needs Plans are a type of Medicare Advantage plan. These plans are commonly called Dual-Eligible Special Needs Plans or D-SNP’s. You must be eligible for both Medicare and Medicaid to be eligible to participate in a Special Needs Plan. Many plans offer additional benefits such as help with paying for groceries, over-the-counter (OTC) pharmacy products or even utilities.

How Do Medicare Special Needs Plans (SNP's) Work

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

Because they offer all health care services through a single plan, Medicare SNP’s can help you manage your different services and providers. They can make it easier for you to follow your doctor’s orders related to diet and prescription drug use. Medicare SNP’s for people with both Medicare and Medicaid may also help people get help from the community and coordinate many Medicare and Medicaid services.

Just like with other Medicare health plans, if you join a Medicare SNP, you will have to see providers who belong to the plan, or use certain hospitals to get covered services. In most cases, you will need referrals to see specialists. The Medicare SNP will still cover emergency or urgently needed care, even if you’re out of the plan’s service area.

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What You Need to Know

If you decide to join a Medicare SNP, you should know the following:

You’re still in the Medicare Program

You still have Medicare rights and protections

You still get complete Medicare Part A and part B coverage through the plan

You get Medicare prescription drug coverage through the plan

The plan may offer extra benefits tailored to the groups it serves, such as diabetes services, care coordination, and/or other health and wellness programs.

You generally still pay the Part B premium (in some cases the plan may cover part or all of the Part B premium as a plan benefit). You generally will also pay a Medicare SNP premium that helps cover costs of providing Part A and B benefits, prescription drug coverage, and any other extra benefits the plan offers

If you have Medicare and Medicaid, or have limited income and resources, some or all of your plan’s out-of-pocket costs may be covered. Contact your State Medical Assistance (Medicaid) office to learn more. Visit www.medicare.gov/contacts, or call 1-800-MEDICARE (1-800-633-4227) for the phone number. TTY users should call 1-877-486-2048

If you’re not satisfied with your care in the Medicare SNP, you can choose another Medicare plan or return to Original Medicare.