Chronic Conditions & Medicare: Special Needs Plan (SNP)

If you have a chronic condition, you may be able to get a special Medicare plan called a special needs plan (SNP). It’s a type of Medicare Advantage Plan that is limited to people with certain diseases or conditions. A Medicare SNP provides coverage for hospital stays, office visits, prescription drugs, and all other Medicare-covered services.

To join a Medicare SNP, you must have Medicare Part A and Part B. You also must live in the plan’s service area. Then, you may be eligible if at least one of these is true for you:

• You have one or more severe or disabling chronic conditions.
• You live in a nursing home or need nursing care at home.
• You have Medicare and Medicaid.

Benefits of Medicare SNP

A Medicare SNP combines hospital, medical, and prescription drug benefits. That makes it easier to coordinate all the parts of your care, makes it easier to follow your doctor’s advice for diet and prescriptions, and can help you get help from the community. All of your medical services are provided through a single plan.

Once you are enrolled in a plan, before you receive a service, it is important to make sure the SNP plan covers the services you need. If you are not sure, you can ask the plan for a decision in advance to make sure the service is covered.

A Medicare SNP is designed just for you. An SNP tailors your benefits, doctors, and drug coverage to meet your specific needs. If you have congestive heart failure, your SNP might offer special programs to manage care for people with congestive heart failure. It also might help you find doctors who specialize in treating it.

Texas Chronic Condition SNPs (Special Needs Plans) are designed for consumers diagnosed with chronic conditions such as diabetes, chronic heart failure, and/or cardiovascular disorders. 

Chronic Health Plans are Medicare Advantage Plans that are a type of Medicare health plan offered by a private company that contracts with Medicare to provide all your Part A and Part B benefits. Most Medicare Advantage Plans also offer prescription drug coverage. If you’re enrolled in a Medicare Advantage Plan, most Medicare services are covered through the plan. Your Medicare services aren’t paid for by Original Medicare. 

These plans offer benefits in addition to those covered under Original Medicare such as routine dental, vision, hearing, transportation, and routine podiatry services. Consumers must have a qualifying chronic condition to enroll. 

You can get your Texas Medicare benefits through Original Medicare, or you can choose a Medicare Advantage Plan. With Original Medicare, the government pays for your Medicare benefits when you get them. Medicare Advantage Plans, Part C of Medicare are offered by private companies that have been approved by Medicare. Medicare pays these companies to administer your Medicare benefits.

If you join a Texas Medicare Advantage Plan, the plan will provide all your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage. They are completely different than a Medicare Supplement Insurance (Medigap) policy.

Chronic Special Needs Plans (C-SNPs): C-SNPs provide specialized and focused health care for specific groups of people, like those who have both Medicare and Medicaid, live in a nursing home, or have certain chronic medical conditions.

To be eligible to enroll in a Texas Medicare Advantage plan you must have both Medicare Parts A and B and live in the plan’s service area. People with End-Stage Renal Disease (permanent kidney failure) cannot enroll in a Medicare Advantage Plan.

You must continue to pay your Part B premium and generally pay one monthly premium for the services included in a Medicare Advantage Plan. Each Medicare Advantage Plan has different premiums and costs for services, so it’s important to compare plans in your area and understand plan costs and benefits before you join. Some may have a $0 premium.

Texas Medicare Advantage Plans must cover all the services that Original Medicare covers except for hospice care. Original Medicare will cover hospice care even if you are in a Medicare Advantage Plan. In all types of Medicare Advantage Plans, you will always be covered for emergency and urgent care. Medicare Advantage Plans must offer emergency coverage outside of the plan’s service area (but not outside the U.S.). Many Medicare Advantage Plans also offer extra benefits such as dental care, eyeglasses, or wellness programs.

Most Medicare Advantage Plans include Medicare prescription drug coverage (Part D). In addition to your Part B premium, you usually pay one monthly premium for both the plan’s medical and prescription drug coverage.

The Medicare Advantage plans all come with the same basic coverage, and Medicare has created and designed that coverage, even though it is not the one selling the plans. Medicare simply oversees Advantage plans and ensures they are being sold and marketed properly. The insurance companies that sell these plans are allowed to add some coverage on top of the basic plans and create a lineup that offers what their customers might want.

Remember, plan benefits can change from year to year. Make sure you understand how a plan works before you join.