Medicare Special Needs Plans (SNPs) must provide you with the same benefits as Original Medicare but may do so with different rules, restrictions, and costs. SNPs can also offer additional benefits. Below is a list of general cost and coverage rules for Medicare SNPs. Remember to speak to a plan representative to learn the details about any plan you are considering.

Costs

  • Plans may charge a monthly premium in addition to the Part B premium.
  • Plans may set their own deductibles, copayments, and other cost-sharing for services.
    • If you have Medicaid, you should not pay Medicare deductibles and copays while seeing providers in your Dual Eligible SNP’s (D-SNP’s) network.

Providers

  • Plans may help manage your care by providing:
    • Access to a care manager who will assess your needs and provide supervision
    • Coordination of your Medicare and Medicaid benefits, if you are enrolled in a D-SNP
  • Depending on your plan, you may have coverage for out-of-network care. However, you may pay a higher amount for out-of-network services. Check with your plan before seeing an out-of-network provider.
  • SNPs cannot charge more than Original Medicare charges for certain kinds of care, including chemotherapy, dialysis, and skilled nursing facility (SNF) care. However, SNPs can charge higher copays for other services, including home health, durable medical equipment (DME), and inpatient hospital care.

Benefits

  • All SNPs are required to provide Part D coverage.
  • Your SNP may offer additional benefits, such as vision, hearing, or dental care. Check with the plan directly to learn about coverage rules and restrictions for any added benefits.

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