Medicare beneficiaries’ health needs can become increasingly complex and specialized as they age. This is why the Centers for Medicare and Medicaid Services have launched the Chronic Condition Special Needs Plan (C-SNP) program. C-SNP is designed to provide comprehensive health coverage to those who qualify. To qualify, individuals must have at least one of the 15 chronic health conditions listed in this post. This post will provide a comprehensive list of the 15 health conditions that qualify for the C-SNP program and explain the additional benefits associated with the program.

What is a C-SNP Medicare Advantage Plan?

C-SNP stands for “Special Needs Plan,” and these plans are designed to meet the unique needs of specific populations, such as those who have chronic conditions. These plans provide comprehensive medical and prescription drug services coverage, with the added benefit of having a designated care coordinator to help patients manage their care. This article will explore a C-SNP Medicare Advantage Plan and how it can help you get the most out of your Medicare coverage.

It’s essential to understand which chronic conditions qualify for a C-SNP plan and how to enroll in such a plan. We’ll discuss which chronic conditions qualify for the program, how to enroll, and the benefits C-SNP plans offer.

Understanding the C-SNP plan and its associated qualifications can help individuals decide how to best manage their chronic conditions. Remember that these plans are only offered in some areas and are specific to the chronic condition. For example, you can’t enroll in a COPD C-SNP program if you only have diabetes. Next, it will cover what’s needed to enroll in a C-SNP plan.

Qualifications to Enroll in a C-SNP

To enroll in a Chronic Special Needs Plan, an individual must maintain an active Medicare Part A and Part B. They must also live in a service area where the plan is available and have one of the Centers for Medicare & Medicaid Services approved chronic conditions.

15 SNP-Specific Chronic Conditions

The Centers for Medicare and Medicaid Services have named the conditions below as allowable chronic conditions to qualify for a Chronic Special Needs Plan. However, there may only be plans for some conditions in some areas. Medicare Advantage plan sponsors can develop an SNP plan for these conditions.

Chronic alcohol and other drug dependence

  • Autoimmune disorders are limited to:
    • Polyarteritis nodosa
    • Polymyalgia rheumatica
    • Polymyositis
    • Rheumatoid arthritis
    • Systemic lupus erythematosus
  • Cancer, excluding pre-cancer conditions or in-situ status
  • Cardiovascular disorders are limited to:
    • Cardiac arrhythmias
    • Coronary artery disease
    • Peripheral vascular disease
    • Chronic venous thromboembolic disorder
  • Chronic heart failure
  • Dementia
  • Diabetes mellitus
  • End-stage liver disease
  • End-stage renal disease (ESRD) requiring dialysis
  • Severe hematologic disorders limited to:
    • Aplastic anemia
    • Hemophilia
    • Immune thrombocytopenic purpura
    • Myelodysplastic syndrome
    • Sickle-cell disease (excluding sickle-cell trait)
  • HIV/AIDS
  • Chronic lung disorders are limited to
    • Asthma
    • Chronic bronchitis
    • Emphysema
    • Pulmonary fibrosis
    • Pulmonary hypertension
  • Chronic and disabling mental health conditions are limited to:
    • Bipolar disorders
    • Major depressive disorders
    • Paranoid disorder
    • Schizophrenia
    • Schizoaffective disorder
  • Neurologic disorders limited to
    • Amyotrophic lateral sclerosis (ALS)
    • Epilepsy
    • Extensive paralysis (i.e., hemiplegia, quadriplegia, paraplegia, monoplegia)
    • Huntington’s disease
    • Multiple sclerosis
    • Parkinson’s disease
    • Polyneuropathy
    • Spinal stenosis
    • Stroke-related neurologic deficit
  • Stroke

Most Common Chronic Condition Special Needs Plans

Despite all the conditions listed above, only a few common C-SNPs exist. The most common C-SNP programs will be for Diabetes Mellitus, congestive heart failure, cardiovascular disorders, and chronic lung disorders. There may be a Chronic Special Needs plan for these other conditions listed, but there are few and far between.

C-SNP Programs for Congestive Heart Failure and Cardiovascular Disorders

This C-SNP provides comprehensive coverage for chronic venous thromboembolism, chronic heart failure, cardiac arrhythmias, coronary artery disease, and peripheral vascular disease. A team of cardiology specialists will collaborate with you and your physician to ensure you receive the optimal care plan.

C-SNP Programs for Diabetes Mellitus

Patients enrolled in a C-SNP for diabetes are typically provided with comprehensive care. The care can include blood glucose monitoring, insulin management, nutrition education, foot care, vision, hearing, and dental care. Primary care physicians, endocrinologists, and other specialists collaborate to develop an individualized care plan for each patient.

C-SNP Programs for Chronic Lung Disorders

C-SNPs provide personalized care for individuals suffering from pulmonary conditions, including COPD, asthma, chronic bronchitis, pulmonary hypertension, and emphysema. A pulmonologist will work with your primary healthcare provider to devise a comprehensive treatment plan, including medications, medical equipment, and oxygen supplies. This plan will ensure optimal management of your overall health and well-being.

C-SNP Programs for End-Stage Renal Disease

If you have this renal impairment, your healthcare team will consist of your primary physician and a nephrologist. You will receive personalized care, nutrition education, required therapies, and prescription drug reimbursement.

When Can I Join a Chronic Condition Special Needs Plan?

You must also be diagnosed with a qualifying condition for the C-SNP plan. Below is the information about enrolling in a C-SNP program for the qualifying condition.

When you reach age 65, you can join a Medicare SNP during your Initial Enrollment Period. During the Medicare Annual Enrollment Period, individuals are eligible to enroll in a Medicare SNP if they qualify, with coverage to take effect on January 1.

Suppose you have a chronic disability and receive Social Security benefits before age 65. In that case, you can enroll in a Medicare SNP plan within a 6-month window starting three months before and ending three months after your 25th month of disability.

Individuals diagnosed with a chronic condition can enroll in a C-SNP at any time if they have Original Medicare or a Medicare Advantage plan. Enrolling in the program will conclude the Special Election Period.

If your condition improves so that you no longer qualify for your C-SNP, you will be disenrolled from the plan. However, you will have a Special Election Period to switch to another Medicare Advantage plan or revert to Original Medicare.

What Does a Chronic Special Needs Plan Health Plan Cover?

C-SNPs must include all prescription drugs in their coverage; they can even offer $0 copays for drugs on their formulary. In addition, they provide comprehensive coverage for dental, vision, and hearing care, making it simple to manage.

Care coordinators and their care teams have been specifically trained to aid plan members. They assist in obtaining the necessary healthcare providers, medications, and other resources to ensure optimal health maintenance. They may be assigned to work one-on-one with a plan member by utilizing C-SNPs.

Some plans even include allowances covering eligible nutritional items, over-the-counter products, utility charges, rental support, domestic necessities, living expenses, pet-related expenses, and beyond.

FAQs

What qualifies for a Chronic Condition Special Needs Plan?

To qualify for a C-SNP plan, the individual must have at least a qualifying chronic condition and must have Medicare Parts A and B. Additionally, the individual must require additional assistance to manage their chronic conditions, as determined by their primary care provider.

What does C-SNP cover?

C-SNP programs cover a wide range of services, including primary and specialty care visits, hospitalization, prescription medications, laboratory services, mental health and substance use disorder services, durable medical equipment, home health services, and inpatient and outpatient rehabilitation.

C-SNP also offers a variety of wellness programs and services to help individuals manage their chronic conditions and improve their quality of life. Moreover, C-SNP members receive case management services to ensure they receive the necessary services and support to meet their needs. C-SNP is an excellent resource for individuals living with chronic illnesses

What are the differences between D-SNP and C-SNP Medicare Advantage Program?

The Difference between a D-SNP and a C-SNP Medicare Advantage program is significant. People with certain chronic conditions qualify for a C-SNP. Dual-eligible individuals can enroll in D-SNPs. Dual-eligible means they are enrolled in both Medicare and Medicaid. These plans often provide additional benefits, such as transportation and meals, that traditional Medicare does not typically cover.

What are the three types of SNP plans?

There are three kinds of Medicare Advantage Special Needs Plans.

  • I-SNPs are for Medicare beneficiaries that live in an institutionalized setting such as a nursing home or long-term care facility.
  • C-SNPs help individuals with chronic health conditions.
  • D-SNPs require enrollees to have both Medicare and Medicaid.

What is the cost of a C-SNP?

The cost of Special Needs Plans can vary depending on where you live and the insurance company. Many chronic condition Special Needs Plans have $0 premiums and low cost-sharing.

Help Finding a C-SNP for your Chronic Condition

A Chronic Special Needs Plan will provide additional benefits and cater to the coverage around the needs of your health condition. Our licensed insurance agents can help you find the right plan for your situation.

Getting help is easy. Simply fill out our online request form or give us a call. We specialize in Medicare and love to help people save money and get better healthcare coverage.

 

Written By:
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Lindsay Malzone, Lindsay Malzone is the Medicare editor for Medigap.com. She's been contributing to many well-known publications since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.
Reviewed By:
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Rodolfo Marrero, Rodolfo Marrero is one of the co-founders at Medigap.com. He has been helping consumers find the right coverage since the site was founded in 2013. Rodolfo is a licensed insurance agent that works hand-in-hand with the team to ensure the accuracy of the content.