Special Needs Plans Services

Special Needs Plans (SNPs) offer different services and have different costs, like all Medicare Advantage (Part C) plans. All SNPs must provide Medicare drug coverage (Medicare Part D) as part of their benefits packages. Each plan will have a different list of covered drugs and work at various drug stores, or pharmacy networks.

Most special needs plans generally only cover doctors and hospitals in the specific plan’s network. This means you may have to pay in full to see any doctor or provider outside of your plan’s network. It’s important to remember that Medicare Advantage (Part C) plans work differently than Original Medicare Part A & Part B. Original Medicare Part A & Part B will cover you to go to any hospital and see any doctor that accepts Medicare payments. If you have both Medicare and Medicaid (which is also called dual-eligible), Special Needs Plan (SNP) providers cannot charge you Medicare deductibles or copays.

All special needs plans should provide services to help manage your healthcare. However, services can vary from one plan to another. Unique services from a special needs plan may include:

  • Regular access to a care manager (a nurse, specially trained educator, or doctor) who will assess your needs and advise you on how to best manage your health conditions.
  • Coordination of your Medicare and Medicaid coverage if you are in a dual-eligible special needs plan (D-SNP).

An important reminder for special needs plan services: dual eligible special needs plan providers cannot charge you for Medicare copays. Also, the special needs plan might offer you easier access to Medicaid-covered services (e.g., transportation).

Before joining any special needs plan, you should review the plan benefits and covered services it offers to understand your options and how it works. Contact Medicare Pathways and speak with a licensed sales agent. We can help review your current health plan and find options to meet your medical and financial needs! Call 866-466-9118 for more information regarding your Medicare health plan options.