Medicare Advantage Chronic Condition Special Needs Plans (C-SNPs) are designed to help individuals with severe or disabling chronic conditions manage their health and access specialized care. These plans offer a range of benefits tailored to the needs of people with specific conditions, potentially at a lower cost than traditional Medicare or standard Medicare Advantage plans.  

Understanding C-SNPs

C-SNPs are a type of Medicare Advantage plan, which means they are offered by private insurance companies approved by Medicare. Unlike traditional Medicare, which allows you to see any doctor or hospital that accepts Medicare, Medicare Advantage plans typically require you to use a network of providers. However, they may offer extra benefits*, such as routine dental, vision, hearing, and prescription drug coverage, that are not included in Original Medicare. 

*In marketing materials, whenever benefits of a C-SNP are listed, you should see a special disclaimer, called an SSBCI disclaimer. An SSBCI disclaimer will convey that the specific benefits being mentioned are part of a special supplemental benefits program, and should list the chronic condition(s) the enrollee must have to be eligible for the SSBCI offered. This is to ensure potential beneficiaries know that potential benefits may differ depending on the insurance provider and specific plan, and eligibility determines on the verification of a qualifying chronic condition.

Who Qualifies for a C-SNP?

To qualify for a C-SNP, you must meet certain eligibility criteria:

• Medicare Eligibility: You must be eligible for Medicare Part A and enrolled in Part B.  
• Chronic Condition: You must have one or more of the specific chronic conditions covered by the plan. These conditions can vary by plan, but the Centers for Medicare and Medicaid Services (CMS) outlines 15 conditions, that you can see below:
  • Chronic alcohol and other drug dependence 
  • Autoimmune disorders limited to:
    • Polyarteritis nodosa
    • Polymyalgia rheumatica
    • Polymyositis
    • Rheumatoid arthritis
    • Systemic lupus erythematosus  
  • Cancer, excluding pre-cancer conditions or in-situ status  
  • Cardiovascular disorders limited to:
    • Cardia arrhythmias
    • Coronary artery disease
    • Peripheral vascular disease
    • Chronic venous thromboembolic disorder
  • Chronic heart failure
  • Dementia
  • Diabetes
  • End-Stage Liver Disease
  • End-Stage Renal Disease (ESRD): Kidney failure requiring dialysis or transplant
  • Severe hematologic disorders limited to:
    • Apastic aneima
    • Hemophilia
    • Immune thrombocytopenic purpura
    • Myelodyspatic syndrome
    • Sickle-cell disease (excluding sickle-cell trait)
  • HIV/AIDS: A chronic immune system disease caused by the human immunodeficiency virus.  
  • Chronic lung disorders limited to:
    • Asthma
    • Chronic bronchitis
    • Emphysema
    • Pulmonary fibrosis
    • Pulmonary hypertension
  • Chronic and disabling mental health conditions limited to:
    • Bipolar disorders
    • Major depressive disorders
    • Paranoid disorder
    • Schizophrenia
    • Schizoaffective disorder
  • Neurologic disorders limited to:
    • Amyotrophic lateral sclerosis (ALS, also known as Lou Gehrig’s Disease)
    • 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
• Doctor’s Confirmation: Your doctor must confirm that you have the chronic condition(s) covered by the plan. This is done by having your doctor complete a Chronic Illness Verification Form, that will be specific to your insurance provider. You can see an example of a Chronic Illness Verification Form here.
  

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Benefits of C-SNPs

C-SNPs offer several advantages for individuals with chronic conditions*:

• Specialized Care: C-SNPs often have a network of providers with expertise in managing your specific condition. This can make it easier to get the specialized care you need.  
• Care Coordination: C-SNPs often have dedicated care coordinators who can help you navigate the healthcare system, manage your medications, and connect with resources and support services.  
• Potentially Lower Costs: C-SNPs may have lower out-of-pocket costs for services related to your chronic condition. They often have reduced copays or coinsurance for specialist visits, medications, and other treatments.  
• Extra Benefits: C-SNPs may offer benefits specifically designed to help you manage your chronic condition, such as specialized medications and therapies, medical equipment and supplies, nutritional counseling, and support groups.  

*Benefit(s) mentioned may be or are part of a Special Supplemental Benefits (program) for the Chronically Ill (SSBCI). You may qualify if you have a high risk for hospitalization and/or require intensive care coordination for one of, but not limited to, the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.  To learn more about other eligibility requirements needed to qualify for SSBCI benefits, please refer to the plan’s Evidence of Coverage.

Important Considerations About C-SNPs

• Network: Make sure your preferred doctors and hospitals are in the plan’s network.
• Costs: Compare premiums, deductibles, copays, and out-of-pocket maximums.
• Benefits: Review the plan’s specific benefits to ensure they align with your needs.
• Enrollment Periods: You can typically enroll in a C-SNP during your Initial Enrollment Period, Annual Enrollment Period, or a Special Enrollment Period if you have a qualifying life event.

If you have a chronic condition, a C-SNP could be a valuable option for managing your health and accessing specialized care. Licensed insurance agents at SmartMatch can assist you in viewing plan options and helping you through the process to verify your eligibility.