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Medicare Special Needs Plans

Medicare Special Needs Plans - Patient Resources, Social Work Services Quick Guide, Social Work Manual, Population Specific, Transplant, Kidney Transplant, Financial

Focus

Medicare Special Needs Plans (SNPs) are a kind of Medicare Advantage plan.

The plan can choose the population it is equipped to serve and CMS must approve those plans. There are SNPs for people who are dual eligible (Medicare + Medicaid), or for people in institutional settings, or those who have chronic conditions.

In the past a very few SNPs have accepted people with ESRD. The state-specific Medicare & You booklet lists what SNPs are available in that state.

Like Medicare Advantage plans, SNPs have provider networks and approved formularies. MA plans can have out-of-pocket costs (deductibles, copays, coinsurance) up to $6,700 a year (mandatory maximum). If someone has a Medigap plan, it won’t pick up those out-of-pocket costs.

CMS publishes “landscape of local plans” zip files, one of which lists SNPs. It appears SNPs accepting people with ESRD are in some CA and NV counties only, but check the state-specific Medicare & You booklet to make sure.

Beth Witten MSW ACSW LSCSW
Resource and Policy Associate
Medical Education Institute, Inc.

11/8/2014