C-SNPs are Medicare Advantage (Part C) plans designed for people with chronic conditions. To be eligible, you must qualify for Medicare. Benefits vary by plan, but plans always include prescription drug coverage (Medicare Part D).
Around two-thirds of Medicare beneficiaries have multiple chronic conditions that require care from a combination of primary care professionals, medical and mental health specialists, inpatient and outpatient facilities, and other diagnostic testing and treatment services.
Chronic Condition Special Needs Plans (C-SNPs) are designed for this purpose. Read on to learn more about C-SNPs, the conditions they cover, the benefits they offer, and how they differ from other SNPs.
A C-SNP is a type of Medicare Advantage Special Needs Plan (SNP) that enrolls only people who have severe or disabling chronic conditions.
By coordinating the multiple types of care that you might need when living with a chronic condition, a C-SNP can make it easier for you to receive care, can offer you additional helpful benefits, and may even help improve your overall outlook.
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Medicare Advantage is generally required to offer the same coverage as Original Medicare (Parts A and B). Some plans include additional benefits.
Like all SNPs, C-SNPs are offered by Medicare Advantage, typically as Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) private insurance plans. These plans may provide additional services specifically targeted to people with chronic conditions.
All SNPs are required to offer Part D coverage for prescription drugs. In addition, under a C-SNP, you might be able to access a network of healthcare professionals with specific expertise in your condition or more comprehensive coverage for necessary prescription drugs.
If you have a serious illness that requires hospitalization, such as cancer or congestive heart failure, an SNP may cover extra days in the hospital.
Other benefits include meal delivery, telehealth, and transportation.
What conditions are covered under a C-SNP?
C-SNPs admit people who have chronic conditions in one or more of the following categories:
- alcohol use disorder or dependence
- certain autoimmune disorders
- cancer (not including in-situ or other precancerous symptoms)
- certain heart conditions
- dementia
- diabetes
- end stage liver disease
- ESKD with dialysis
- certain blood disorders
- HIV and AIDS
- certain lung conditions
- certain mental health conditions
- stroke and certain other brain disorders
The Centers for Medicare & Medicaid Services website provides a full list of the specific conditions.
A D-SNP is another type of SNP that provides extended Medicare coverage. Like other types, it helps coordinate care and benefits.
The difference is that D-SNPs are specifically for people who qualify for both Medicare and Medicaid — about 12 million people fit into this category.
D-SNPs have more eligibility requirements, but the benefits they provide are more comprehensive.
The third type of SNP is an Institutional Special Needs Plan (I-SNP). This is a plan geared toward people who need an extended stay at a medical institution, such as a long-term care or skilled nursing facility.
Long-term care nursing centers, intermediate care centers for people with intellectual disabilities, and residential mental health facilities also qualify.
In order to be eligible, you need to stay at such a facility for at least 90 days.
How do you enroll in a C-SNP?
To enroll in an SNP, you need to be currently enrolled in either Original Medicare or Medicare Advantage. Additionally, you need to meet the specific qualifications for the particular SNP that you’re interested in. In the case of a C-SNP, you must have one or more qualifying conditions.
How much do C-SNPs cost?
Because Medicare Advantage plans are offered by private insurance companies, the premiums and deductibles for C-SNPs can vary. But under a C-SNP, you can’t be charged more than Original Medicare would charge for certain services, such as chemotherapy, dialysis, and skilled nursing facility care.
A C-SNP is one of the three types of Special Needs Plans (the other two are D-SNP and I-SNP). It’s a Medicare Advantage program that helps coordinate care and offers additional benefits to people who live with chronic health conditions.
Anyone who has one of the 15 eligible conditions and qualifies for Medicare can join a C-SNP. The specific benefits of each plan may differ depending on the insurance company, but these plans must always include coverage for prescription drugs (Medicare Part D).