Chronic Condition Special Needs Plans (C-SNPs): Plans Tailored to Better Manage Chronic Conditions

In this article:  

What is a Chronic Condition Special Needs Plan or C-SNP?	Jump to
Which Chronic Conditions are covered?	Jump to
What if I Have More Than One Chronic Condition?	Jump to
When Can I Enroll in a C-SNP?	Jump to

What is a Chronic-Condition Special Needs Plan or C-SNP?

Medicare Advantage Plans are not a “one-size-fits-all” type of health care plan. There are many variations, designed with different goals in mind. Chronic Condition Special Needs Plans (C-SNPs) are a special type of Medicare Advantage Plan targeted for people with chronic or disabling health conditions.

What is a SNP?

C-SNPs are part of a larger category of Special Needs Plans (SNPs). SNPs limit membership to people with specific diseases or characteristics. The reason why is because these plans offer benefits and services not found in other types of Medicare Advantage (Medicare Part C) in addition to all the Medicare services that all Medicare Advantage plans must cover.

One of the most notable benefits of a SNP is the use of care coordinators. These care coordinators help you stay on track with your care. For example, a care coordinator can help schedule appointments, get the right prescription drugs and monitor other health-related activities.¹

Do I get Prescription Drug Coverage with a C-SNP?

Yes. All SNPs are required to include prescription drug coverage.

Other types of SNPs

There are three types of SNPs: Chronic Condition SNPs, Institutional Special Needs Plans (I-SNP) and Dual-Eligible Special Needs Plans (D-SNP)

• I-SNPs are for people who live in an institutional care facility, like a nursing home, or require nursing care at home.
• D-SNPs are for people who have both Medicare and Medicaid.

How do I qualify for a C-SNP?

You can join a Chronic Condition Special Needs Plan if you meet the plan’s requirements. You must:

• Have Medicare Part A (hospital insurance)
• Have Medicare Part B (medical insurance)
• Live in the plan’s service area
• Have a qualifying chronic condition

Which Chronic Conditions are Covered Under a C-SNP?

There are 15 SNP-specific chronic conditions as recognized by the Centers for Medicare and Medicaid Services (CMS). Some of these conditions are limited to conditions within a broader category of illness. These chronic conditions include:²

Chronic Conditions Qualifying for C-SNP
Condition	Limited to:
Chronic alcohol and other drug dependencies
Autoimmune disorders	Polyarteritis nodosa, polymyalgia rheumatica, polymyositis, systemic lupus erythematosus
Cancer excluding pre-cancer conditions or in-situ status
Cardiovascular disorders	Cardiac arrhythmias, coronary artery disease, peripheral vascular disease, chronic venous thromboembolic disorder
Dementia
Diabetes mellitus
End-stage liver disease
End-stage renal disease (ESRD) requiring dialysis
Chronic heart failure
Severe hematologic disorder	Aplastic anemia, hemophilia, immune thrombocytopenic purpura, myelodysplastic syndrome, sickle-cell disease excluding sickle-cell trait)
HIV/AIDS
Chronic lung disorders	Asthma, chronic bronchitis, emphysema, pulmonary fibrosis, pulmonary hypertension
Chronic and disabling mental health conditions	Bipolar disorders, major depressive disorders, paranoid disorder
Neurologic disorders limited to:	Amyotrophic lateral sclerosis (ALS) , 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

What if I Have More Than One Chronic Condition?

When completing a C-SNP application, your insurance company may apply to offer a plan that targets one of the following:

• A single CMS-approved chronic condition
• A CMS-approved group of common co-morbid or clinically linked conditions
• A group of multiple chronic conditions customized by your insurance provider

C-SNPs are typically tailored around one chronic condition because trying to treat multiple chronic conditions may dilute the treatment resulting in a more generalized care plan.

However, CMS does allow for C-SNPs that target groups of commonly co-morbid, happening simultaneously, and clinically linked conditions. There are five groups of multi-condition groups:²

• Group 1: Diabetes mellitus and chronic heart failure
• Group 2: Chronic heart failure and cardiovascular disorders
• Group 3: Diabetes mellitus and cardiovascular disorders
• Group 4: Diabetes mellitus, chronic heart failure and cardiovascular disorders
• Group 5: Stroke and cardiovascular disorders

If your insurance provider is approved to offer a C-SNP that targets any of the plan groups above, you only need to have one of the qualifying conditions in the group for enrollment. CMS will review your insurance provider’s Model of Care – care plan – before approving the plan.

Alternatively, your insurance provider may have their own multi-condition C-SNPs. Those have different approval requirements by CMS which need to be met before plans are approved.

When Can I Enroll in a C-SNP?

If you meet the eligibility requirements for C-SNP, you can enroll in a SNP at any time as a special enrollment period. However, once you join the plan, your special enrollment period ends.¹