Your Medicare Special Needs Plan (SNP) Rights

Special Needs patients who join SNP Plans are sometimes not aware that their rights are well protected under the rules and regulations of Medicare. Despite the fact that a private company managed the SNP Plan, your Medicare rights are still very much in effect and in fact this year they have become even stronger for SNP patients.

SNP Patients have the Right to an Appeal

SNP Patients have the right to appeal any decision made regarding their care or the payment of their care. SNP Plans are bound to provide the same services and coverage available under Original Medicare Parts A, B and D. If you feel that something should be covered and it hasn't been or you feel that you need care that you have been denied you can appeal the decision. First, the appeal is reviewed by the plan. If you are still unhappy with their decision then you can ask that it be heard by another review panel that is employed by Medicare.

The SNP company must provide you with written guidelines about how to file an appeal. If you feel that their decision is going to seriously harm your health you can request what is called a fast decision. This means that the company is required to give you a decision on your appeal within 72 hours. Fast decisions are often related to hospital stays and nursing home care.

SNP Plans and Medicare have time periods that must be met in order to have additional care covered under Medicare. For example the standard hospital stay must be four days/three nights AFTER admittance for subsequent skilled nursing home care. Sometimes a clerical error occurs and a patient isn't admitted properly. When the bills for your nursing home care arrive at the insurance company all they will see is that the patient didn't meet the three-night hospital requirement and they won't pay the bill for the nursing home. An appeal to them with proof of the date you entered the hospital is usually enough to sort out the problem. It helps to remember that both hospital and insurance administrators handle a lot of paperwork and no system is infallible or perfect. As a patient, it is your responsibility to keep track of your own care, know your rights and file an appeal when necessary to rectify any care or billing problem. There are additional Patient's Right Advocacy Groups that can help you know and understand your Medicare Rights.

Protected Patient's Rights under Medicare and your SNP Plan

The following is a list of the basic rights protected by Medicare. Get to know this list and anytime you think your rights are being violated, speak up!

All Medicare SNP Patients have:

  • The Right to be treated and cared for respectfully.
  • The Right to be involved in making health care decisions.
  • The Right to care and services when you need them.