Being diagnosed with a new chronic condition is always scary. It doesn’t just impact you physically; it can take an emotional and financial toll as well. Having one chronic condition can double your annual healthcare spending. While your doctor is managing your condition, you can maintain your budget by ensuring you have the best health plan for your new care needs. Read on to find out about chronic condition Medicare plans.
Can you change Medicare plans after being diagnosed with a health condition?
If you’re enrolled in Medicare Part A and Part B and receive a diagnosis for a health condition that qualifies for a C-SNP, you can enroll in a C-SNP through a Special Enrollment Period. This Special Enrollment Period enables you to enroll in a C-SNP plan outside of the Annual Enrollment Period (October 15 to December 7). Similarly, if you are enrolled in a standard Medicare Advantage plan and are diagnosed with a qualifying condition, you can enroll in a C-SNP at any time through that same Special Enrollment Period. This SEP does not have a time limit like other enrollment periods.
Of note: Your Special Enrollment Period lasts until you enroll in a plan. Once you’ve chosen one, you’ll have to stick with it until the next Annual Enrollment Period or Medicare Advantage Open Enrollment (January 1 to March 31). This would only change if you’re diagnosed with a new qualifying chronic condition. For instance, if you have diabetes, pick a plan and are later diagnosed with another condition, like asthma, you’ll have another Special Enrollment Period to change plans if another one better fits your new health needs.
What are C-SNPs?
Chronic Special Needs Plans are offered through Medicare Advantage plan carriers for people actively receiving care for one or more of 15 different severe chronic health conditions. They tend to be low-premium plans that offer robust coverage and supplementary benefits. When you enroll in a C-SNP, you’ll receive a dedicated healthcare team and a chronic care management plan. These help carriers and providers better coordinate and guide your care using health protocols for your specific condition.
C-SNP benefits built for managing chronic illness
There are a host of supplemental benefits included in C-SNPs. Because they include services and supplies that are needed for each chronic condition, they may help you receive better care at a lower cost.
Some of the additional benefits in C-SNPs are ones offered through Special Supplemental Benefits for the Chronically Ill (SSBCI). These, too, are tailored for a range of chronic conditions geared toward Medicare beneficiaries and are often included or packaged for C-SNP recipients. The supplemental benefits in C-SNPs vary and are customized for each different chronic illness. Some added benefits in the plans include:
- Gym memberships or the Silver Sneakers program,
- Paid specialized equipment and supplies,
- Remote monitoring,
- Routine dental, vision, and hearing,
- A prepaid card for uncovered expenses like healthy food and over-the-counter supplies,
- Transportation to health-related appointments,
- Drug formularies that often have reduced copays for medications and supplies related to your condition.
Through a C-SNP, you’ll also receive a dedicated care manager or a personal care team that provides care coordination. C-SNPs may provide education to help improve your health, like nutrition counseling for diabetes, instructions on inhalers for asthma, and ways to track if your condition is worsening if you have chronic heart failure.
How to qualify and apply for a C-SNP
You’ll need to begin by getting an official diagnosis of one of the 15 eligible conditions from your doctor. You can apply to take part in a C-SNP through an insurance carrier or an independent broker who will ask questions about your health and guide you through the documentation process. A SmartMatch agent can help you understand the required documentation (like medical records) and will notify you when you have everything you need.
After completing the application process, the carrier will reach out to your doctor to get written attestation that you have a qualifying chronic condition. Your doctor will need to confirm your diagnosis within 60 days of your enrollment. Some carriers may enroll you in the plan before receiving confirmation from your doctor. But if they do not receive the letter from your doctor by 60 days, you will be disenrolled from the plan, allowing another 60 day Special Enrollment Period to choose another or reapply.
FAQs about Medicare and chronic diagnoses
Can I keep my doctor if I switch to a C-SNP?
This varies by plan. Check with the carrier to see if your doctor is in the plan’s provider network. If they aren’t, you may be able to request to see them as an in-network provider on the new plan.
What happens if my doctor takes longer than 60 days to sign the verification form?
If the carrier can’t confirm your condition with your doctor within 60 days, you’ll be disenrolled from the C-SNP. You’ll have another Special Enrollment Period where you can keep Original Medicare with a Part D prescription drug plan or switch to another Medicare Advantage plan. The Special Enrollment Period usually starts the month you are disenrolled and lasts for two calendar months after.
Do C-SNPs cost more than standard Medicare Advantage plans?
Typically, they don’t cost more in monthly premiums. Premium rates vary by carrier and plan type. But about 75% of plans have zero premiums and many of the rest are lower than $60 per month. However, they may have higher out-of-pocket maximums.
If you’ve recently been diagnosed with a chronic health condition, it may be wise to look into a Medicare Advantage C-SNP plan. These plans are tailor-made for each specific condition, providing access to specialists, offering supplemental benefits, and covering treatment that addresses your specific needs. A licensed SmartMatch agent can help determine if you qualify for a C-SNP, find the right plan for you, and assist you with the application process.
