CSNPs: Qualification & Enrollment in Chronic Condition Special Needs Plans for Medicare
Key Takeaways
C-SNPs are a type of Medicare Advantage (Part C) plan.
To be eligible for a C-SNP, you must also be eligible for Medicare.
C-SNPs are designed to provide people with chronic or debilitating illnesses the medical care and treatments they need, all in one plan.
C-SNPs always include prescription drug coverage (Medicare Part D).
What is a C-SNP?
C-SNP stands for Chronic Condition Special Needs Plan. C-SNPs are a special type of Medicare Advantage (Part C) plan. Because of the plan’s targeted care, eligible members typically have medical conditions or characteristics in common. If you have a chronic, long-term health condition such as diabetes, dementia or heart disease [i] , you may benefit from having an insurance plan geared specifically towards your unique needs.
The benefits of having a C-SNP include access to hospitals and medical professionals who specialize in your condition or disease. C-SNPs also use drug formularies geared towards the needs of its membership.
Other benefits may include health and wellness programs, nutrition or substance abuse counseling, or diabetes management services. Like other Medicare Advantage plans, C-SNPs may also include extras that don’t specifically pertain to your condition, such as dental and vision coverage.
Some C-SNPs assign you to a care coordinator who provides personal support and oversight of your medical appointments and treatments.
C-SNPs vary in cost as well as coverage. Some plans cost $0 monthly. Others have a monthly premium you’re required to pay, in addition to your Part B premium.
Every C-SNP has a network of providers. Your choice of doctors and hospitals can influence out-of-pocket costs, including:
- Copays
- Coinsurance
- Deductibles for doctor visits, hospitalization and drug coverage
If you stay within your plan’s network, your out-of-pocket costs will be lower than if you use doctors, pharmacies and hospitals outside of the network.
What Is a C-SNP Medicare Plan?
C-SNP Medicare plans are required to cover at least as much as Original Medicare (Part A and Part B). This includes hospitalizations, medical care and preventive care.
C-SNPs also must include prescription drug (Part D) coverage. This enables you to get all your medical needs met through one coordinated plan.
CNSPs are administered by private insurance carriers that are approved by Medicare. Not every plan is available in every county or state.
In some instances, you may be able to choose between an HMO (health maintenance organization) and a PPO (preferred provider organization). Because they’re tailormade to meet the needs of a specific patient population, both types of C-SNP are likely to have fewer coverage limitations than many other Medicare Advantage plans. They may also have lower or differing costs.
If you decide that a CNSP plan is right for you, you won’t need extra drug coverage, or additional insurance, such as Medigap (Medicare Supplement Insurance). You cannot purchase a Medigap plan if you have a Medicare Advantage plan.
Who Qualifies C-SNP?
To be eligible for a C-SNP, you must meet these requirements:
- You are eligible for Medicare.
- You live in the plan’s service area.
- You have been diagnosed with one or more severe or disabling chronic conditions.
The CDC defines a chronic condition or disease as:
- Lasting one or more years.
- Requiring ongoing medical attention and/or limiting activities of daily living.
Your doctor may need to fill out a Chronic Condition Verification Form for the plan’s provider to ensure eligibility.
What Chronic Conditions Qualify for a SNP?
There is a wide range of health conditions that can qualify you for a C-SNP. They include:
Autoimmune disorders, including:
- rheumatoid arthritis
- systemic lupus erythematosus
- polyarteritis nodosa
- polymyalgia rheumatica
- polymyositis
Cancer
Cardiovascular disorders, including:
- coronary artery disease
- peripheral vascular disease
- cardiac arrhythmias
- chronic venous thromboembolic disorder
Chronic heart failure
Chronic lung disorders, including:
- asthma
- chronic bronchitis
- emphysema
- pulmonary fibrosis
- pulmonary hypertension
Chronic substance abuse or dependence on alcohol or drugs
Dementia
Diabetes
End-stage liver disease
End-stage renal disease
Hematologic disorders, including:
- hemophilia
- sickle cell disease
- aplastic anemia
- immune thrombocytopenic purpura
- myelodysplastic syndrome
HIV/AIDS
Mental health conditions, including:
- bipolar disorders
- schizophrenia
- major depressive disorders
- paranoid disorder
- schizoaffective disorder
Neurologic disorders, including:
- epilepsy
- extensive paralysis
- ALS (amyotrophic lateral sclerosis)
- Huntington’s disease
- Parkinson’s disease
- multiple sclerosis
- spinal stenosis
- polyneuropathy
- neurologic deficit due to stroke
Stroke
When Can I Enroll in a C-SNP?
If you meet the eligibility requirements for a C-SNP, you can enroll at any time. This is known as a Special Enrollment Period. If you are newly diagnosed or have a worsening condition that makes you eligible for a C-SNP, you don’t have to wait for specific Medicare enrollment periods to join a plan.
If you prefer, you can also enroll for a C-SNP during these timeframes:
Initial Enrollment Period: If you are newly qualified for Medicare due to age, initial enrollment begins three months before your 65th birthday and ends three months after your 65th birthday, for a total of seven months (or four months before and two months after if your birthday is on the first day of the month).
If you are newly qualified for Medicare due to disability, initial enrollment begins three months before the 25th month you receive either Social Security or Railroad Retirement Board disability benefits and lasts for seven months.
Annual Election Period: Your Annual Election Period takes place each year from Oct. 15 to Dec. 7. During this period, you can switch from an existing plan or enroll in a C-SNP for the first time. You can also disenroll from your plan during this time.
