What Is a Chronic Special Needs Plan? A Chronic Condition Special Needs Plan (C-SNP) is a type of Medicare Advantage plan designed for individuals with ongoing disabilities or chronic conditions
What Is a CSNP?
A Chronic Condition Special Needs Plan (C-SNP) is a type of Medicare Advantage plan designed for individuals with ongoing disabilities or chronic conditions. These plans, also known as coordinated care plans (CCPs), offer the same Medicare benefits as other Medicare Advantage (MA) plans available in the same area—along with extra support.
Some of the additional benefits may include:
- Reduced or no out-of-pocket costs for the beneficiary
- Extended coverage for inpatient care
- Longer coverage periods for specialty medical services
- Equal focus on both mental and physical health services
- Extra preventive care services (e.g., dental, vision, hearing screenings, cancer and cardiac screenings based on risk and age)
- Access to social services (such as help connecting with community or transportation resources)
- Wellness programs aimed at managing and slowing the progression of chronic illnesses
To be eligible, a person must have a qualifying chronic condition. These plans do not require medical underwriting, meaning insurers must accept eligible individuals who meet the criteria.
C-SNPS are one of the three types of special needs plans within Medicare Part C (Medicare Advantage).
CMS Identified these five combinations of commonly co-existing chronic conditions:
How Are C-SNPs Different from Medicare Advantage (MA) Plans?
Chronic Condition Special Needs Plans (C-SNPs) are designed for people with one or more chronic conditions. These plans offer tailored benefit packages (PBPs) to help members better manage their health compared to standard Medicare Part A and B coverage or typical MA plans. C-SNPs achieve this by customizing benefits, provider networks, and drug coverage.
According to the Centers for Medicare & Medicaid Services (CMS), these custom PBPs generally include:
- Extra health benefits targeted to the specific chronic condition;
- Provider networks that specialize in treating the condition(s);
- Cost-sharing structures tailored around the chronic condition and any related health issues, covering both Medicare and supplemental benefits.
What Is the SNP Enrollment Process?
Typically, enrollment in a Chronic Special Needs Plan (C-SNP) happens during the Initial Election Period (IEP) or the Annual Enrollment Period (AEP). However, if someone is diagnosed with a new chronic condition, they may qualify for a Special Enrollment Period (SEP), provided they have documentation from a doctor confirming the diagnosis.
This SEP remains available as long as the person meets the qualifying condition and ends once they enroll in a C-SNP. Coverage begins on the first day of the month following enrollment.
Key Point
An SEP for a newly diagnosed chronic condition lasts while the person is eligible and ends when they enroll in a C-SNP.
Once this SEP is used, any future changes to the plan must be made during other standard Medicare enrollment periods. Knowing about this SEP can help you guide clients toward personalized coverage for their condition.
If a member relocates outside their C-SNP’s service area or if the plan discontinues participation in Medicare, members will qualify for a different SEP to choose a new plan.
