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Guide to Chronic Condition Special Needs Plans (C-SNP)

If you're unsure about the different types of Medicare Advantage plans available to you, remember that you are not alone. It can be confusing trying to navigate the benefits and drawbacks of certain Medicare and Medicare Advantage plans, but luckily, we at Alignment Health Plan are here to help you. If you're interested in learning about Chronic Condition Special Needs Plans (C-SNPs), you're in the right place. If you or someone that you care for is living with a chronic condition and needs a Special Needs Plan, we want to make sure that you have all of the information you need to make the best decisions. While living with a chronic condition can come with certain challenges, we at Alignment Health Plan can make sure you have access to the resources you need. 

Whether you need help connecting with specialists in your condition, treatments, or other resources, our team eases the process so you can focus on you. 

 

What Are C-SNPs?

A C-SNP is an acronym for Chronic Condition Special Needs Plan. It is important to understand that Medicare Special Needs Plans (SNPs) do have certain eligibility requirements that can limit coverage to those with qualifying conditions. Due to those requirements, the coverage range varies by condition, making it easier for plan members to access care. C-SNPs have different benefits and extended coverage for those with qualifying chronic health conditions. C-SNPs have the primary purpose of helping individuals with disabling chronic conditions manage their care with ease and convenience.

For example, if someone has congestive heart failure (CHF), C-SNPs designed for people with heart conditions will include access to a network of providers who specialize in CHF. In addition, the individual would also receive prescription drug coverage for specific treatment medications. Simply put, individuals with these plans receive customized care to fit their unique health care needs, which makes these plans a great choice for many people with chronic conditions.

 

Who Qualifies for C-SNPs?

A Medicare C-SNP has several eligibility requirements. To start, patients must have Medicare Part A and Part B eligibility and a diagnosis of certain chronic conditions before they can enroll. Every applicant must meet the requirements of a chronic condition diagnosis specific to that plan. These qualifying health conditions include (but are not limited to):

  • Autoimmune disorders
  • Cancer (precancerous conditions don't qualify)
  • Cardiovascular disorders
  • Chronic alcohol or substance abuse dependency
  • Chronic heart failure
  • Chronic or disabling mental health issues
  • Dementia
  • Diabetes mellitus
  • End-stage liver disease
  • End-stage renal disease
  • HIV/AIDS
  • Neurologic disorders
  • Severe hematological disorders
  • Severe lung disorders such as Chronic Obstructive Pulmonary Disease (COPD) or emphysema

Remember that you can visit the Medicare.gov official website (the official United States government website for Medicare) to access the complete list of qualifying chronic conditions for C-SNPs.

 

What Will Be Covered?

If you or someone you care for is living with one or more of the following chronic conditions, there are special needs plans that you may be eligible for. While the exact plan options available to you will vary depending on a variety of factors such as place of residence and severity of your condition, understanding your possible benefits is valuable. 

Diabetes Mellitus:

If you are someone with this chronic condition, C-SNP coverage will usually include access to tools for blood glucose and insulin management, as well as vision, hearing, foot, and dental care.

Also in many scenarios, there is nutritional training and other forms of extra screening/monitoring that are offered to the patient. With a C-SNP designed for people with diabetes, your primary care physician and your endocrinologist (diabetes specialist) work together and with you to determine what care plan will work best. 

End-Stage Renal Disease (ESRD):

If you are someone with this chronic condition, C-SNP coverage will usually include access to nursing staff and care teams and that work with your primary care physician and nephrologist (kidney-care specialist).

In many cases, ESRD patients with a Special Needs Plan will receive access to personal support, nutritional training, and any other treatments that may be deemed necessary by care providers, including the coverage of prescription medicine tailored to treat this condition. Other types of care such as preventive health screenings, dental, vision, hearing, and more can also be covered. 

Chronic Lung Disorders (COPD, asthma, chronic bronchitis, pulmonary hypertension, emphysema):

If you are someone with this chronic condition, C-SNP coverage will usually include access to oxygen supplies and other medical equipment that you may need. Typically you will also have access to a pulmonologist (lung specialist) that works with your primary care physician on treatment plans, medications, and other health-management-related issues.

Chronic Heart Failure And Cardiovascular Disorders (chronic venous thromboembolic disorder, chronic heart failure, cardiac arrhythmias, coronary artery disease, peripheral vascular disease):

If you are someone with this chronic condition, C-SNP coverage will usually include access to a cardiologist (heart specialist) who will work with you and your primary care physician to determine the best course of action when it comes to ongoing care.

 

When Can I Enroll in a Chronic Condition Special Needs Plan?

C-SNP enrollment occurs from October 15 through December 7 every year, throughout Medicare’s Annual Enrollment Period. Or you can enroll during a Special Election Period, which begins when you turn 65 or meet qualifying conditions for a Medicare Advantage Special Needs Plan. These qualifiers include:

  • Receiving a diagnosis of specific chronic conditions
  • Moving into a medical health institution
  • Moving outside of your plan's service area
 

Frequently Asked Questions About Chronic Condition Special Needs Plans

 

What Are Medicare Chronic Special Needs Plans?

Medicare Chronic Special Needs Plans (C-SNPs) have different benefits and extended coverage for those with qualifying chronic health conditions. C-SNPs have the primary purpose of helping individuals with disabling chronic conditions manage their care with ease and convenience.

 

What Are the Advantages of a Chronic Special Needs Plan?

The extra benefits of Chronic Special Needs Plans are numerous. To start, you can enroll in a Medicare Advantage plan that is customized to your exact care needs, so you can get low-cost or no-cost medical assistance whenever you need it.

 

Who Qualifies for Medicare Chronic Special Needs Plans?

There are specific eligibility requirements for Chronic Special Needs Plans. A Medicare C-SNP has several eligibility requirements. To start, patients must have Medicare Part A and Part B eligibility and a diagnosis of certain chronic conditions before they can enroll. Every applicant must meet the requirements of a chronic condition diagnosis specific to that plan. These qualifying health conditions include (but are not limited to):

  • Autoimmune disorders
  • Cancer (precancerous conditions don't qualify)
  • Cardiovascular disorders
  • Chronic alcohol or substance abuse dependency
  • Chronic heart failure
  • Chronic or disabling mental health issues
  • Dementia
  • Diabetes mellitus
  • End-stage liver disease
  • End-stage renal disease
  • HIV/AIDS
  • Neurologic disorders
  • Severe hematological disorders
  • Severe lung disorders (like COPD or emphysema)
 

Final Thoughts on C-SNP Medicare Advantage Plans

Medicare Special Needs Plans can be confusing, but we take all the confusion out of the process here at Alignment Health Plan. Contact us today to find the right Medicare Advantage plan for you. 

Click here for more frequently asked questions.