Texas Medicare Special Needs Plans
Medicare Advantage Made Easy
Benefits of a Texas Medicare Special Needs Plan
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.
Medicare Special Needs Plans (SNPs) are private companies that the federal government pays to administer Medicare benefits. Like all Medicare Advantage Plans, SNPs must provide you with the same benefits, rights, and protections as Original Medicare, but they may do so with different rules, restrictions, and costs. Some SNPs offer additional benefits, such as vision and hearing care.
Medicare Advantage Plans are health plan options (like an HMO or PPO) approved by Medicare and offered by private companies. These plans are part of Medicare and are sometimes called “Part C” or “MA Plans.” Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. Medicare Advantage Plans provide your Medicare health coverage and usually Medicare drug coverage. These plans are not categorized as supplemental insurance.
Cost and Eligibility
All SNPs are designed to meet specific care needs, and you can only join an SNP if you fit the special needs category the plan serves. SNPs may provide care and coverage coordination services not offered by other types of Medicare Advantage Plan. There are three types of SNPs:
- Chronic Condition SNPs (C-SNPs): For individuals with specific chronic conditions, such as cancer, dementia, diabetes, HIV/AIDS, stroke, End-Stage Renal Disease (ESRD), and certain neurologic disorders
- Institutional SNPs (I-SNPs): For individuals who live in an institution, such as a nursing home, long-term care skilled nursing facility (LTC SNF), intermediate care facility, or assisted living facility
- Dual Eligible SNPs (D-SNPs): For individuals enrolled in Medicare and Medicaid (dually eligible individuals)
You must have both Parts A and B to join an SNP, and generally, you will continue paying your Medicare Part B premium, though some SNPs will pay part of this premium. Some SNPs will charge an additional premium, on top of your Part B premium. You may be eligible for other forms of premium assistance if you are eligible for an SNP. SNPs are also required to provide Part D coverage.
You can enroll in an SNP if you have ESRD if the plan specifically serves individuals with ESRD.
Benefits access basics
Your Medicare SNP may be a Health Maintenance Organization (HMO) or a Preferred Provider Organization (PPO). Depending on your plan, you may need to see in-network providers to receive coverage or have the option of going out of network.
SNPs are not available everywhere. Call 1-800-MEDICARE or your State Health Insurance Assistance Program (SHIP) to find out if there is an SNP available in your area. To enroll in an SNP, call Medicare or the plan directly. Be sure to make an informed decision by contacting a plan representative to ask questions before enrolling.
Many Medicare Advantage (Part C) plans include prescription drug, vision, hearing, and dental coverage not offered by Original Medicare (Parts A & B). Additionally, each Medicare Advantage plan is required by law to feature an annual maximum cap on out-of-pocket costs, meaning once that limit is reached you will pay nothing for additional covered medical services.