Special Needs Plans (SNP) in West Virginia

How Medicare SNPs work in West Virginia

Medicare SNPs are Medicare Advantage Plans (like an HMO or PPO). Medicare Special Needs Plans (SNP) in West Virginia determine membership for people with complex diseases or features. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the precise needs of the groups they serve. 

Can I get my health care from any doctor, other health care provider, or hospital?

Medicare Special Needs Plans (SNP) in West Virginia generally have specialists in the diseases or conditions that affect their members. Some SNPs cover services out of network, and some don’t. Check with the plan to see if they cover benefits out of network and, if so, how it affects your costs.

Are prescription drugs covered? 

All SNPs must provide Medicare drug coverage (Part D).

Do I need to choose a primary care doctor? 

Some SNPs mandate primary care doctors, and some don’t. Check with the plan to see if you need to select a primary care doctor.

Must I have to get a referral to see a specialist?

Some SNPs require referrals, and some don’t. Check with the plan to see if you need a referral. Certain benefits, like yearly screening mammograms, don’t need a referral.

What else do I need to know about this type of plan?

• These groups are qualified to enroll in an SNP: 1) people who live in certain institutions (like nursing homes) or who live in the community but require nursing care at home, or 2) people who are qualified for both Medicare and Medicaid, or 3) people who have distinct chronic or disabling conditions (like diabetes, End-Stage Renal Disease (ESRD), HIV/AIDS, chronic heart failure, or dementia). Health Plans in West Virginia may further limit membership to a single chronic condition or a group of related chronic conditions. You can join an SNP at any time.
• An SNP benefits its members’ individual needs, including care coordination services.
• If you have Medicare and Medicaid
•  Your plan should confirm that all plan doctors or other health care providers you use receive Medicaid.
• If you live in an institution, make sure that plan providers serve people where you live. Find out more about where SNPs are offered.