What Are Chronic Special Needs Plans?

February 24, 2023

What Are Chronic Special Needs Plans?

Chronic condition special needs plans, also called C-SNPS, are special types of Medicare Advantage plans that restrict enrollment to eligible members with specific chronic conditions. These plans include targeted care for these conditions such as diabetes, dementia, or heart disease and cover providers and care tailored to their unique needs. The drug formularies for these plans are also geared toward the needs of its eligible individuals.

Like other Medicare Advantage plans, C-SNPs cover at least as much as Original Medicare Parts A & B, as well as C-SNPs, are required to include prescription drug coverage. This helps ensure eligible individuals can receive all their medical needs in one plan.

 C-SNPs may also assign a care coordinator that works with each beneficiary. Care coordinators help members access medications and healthcare providers that will best aid their care.

Since they are tailored to a specific need of the condition, C-SNPs may have fewer coverage limitations than other Medicare Advantage (Part C) plans and may have lower or differing costs.

Who Qualifies for a C-SNP?

Almost 67% of Medicare enrollees have at least two chronic conditions that require care from primary providers, mental health specialists, inpatient and outpatient care, and ancillary services.

Eligibility Requirements

  • Be eligible for Medicare
  • Live in the plan’s service area
  • Diagnosed with at least one qualifying chronic condition
    • Per the CDC, a condition is chronic if
      • It requires ongoing medical attention and/or limits the ability to perform daily living activities
      • It lasts one or more years

What are the qualifying conditions?

Fifteen specific chronic conditions are qualifying requirements for special needs plans. These may be periodically changed or revised depending on the care coordination through the SNP product.

The 15 conditions that are C-SNP qualifying are as follows:

  • Chronic alcohol and other drug dependence
  • Cancer, excluding pre-cancer conditions
  • Chronic heart failure
  • Diabetes Mellitus
  • Dementia
  • End-stage renal disease requiring dialysis
  • Stroke
  • Neurologic disorders limited to:
    • Amyotrophic lateral sclerosis (ALS)
    • Epilepsy
    • Extensive paralysis
    • Huntington’s disease
    • Multiple sclerosis
    • Parkinson’s disease
    • Polyneuropathy
    • Spinal stenosis
    • Stroke-related neurologic deficit
  • Chronic and disabling mental health conditions limited to:
    • Bipolar disorders
    • Major depressive disorders
    • Paranoid disorder
    • Schizophrenia
    • Schizoaffective disorder
  • Chronic lung disorders limited to:
    • Asthma
    • Chronic bronchitis
    • Emphysema
    • Pulmonary fibrosis
    • Pulmonary hypertension
  • Severe hematologic disorders limited to:
    • Aplastic anemia
    • Hemophilia
    • Immune thrombocytopenic purpura
    • Myelodysplastic syndrome
    • Sickle-cell disease (excluding sickle-cell trait)
  • Cardiovascular disorders limited to
    • Cardiac arrhythmias
    • Coronary artery disease
    • Peripheral vascular disease
    • Chronic venous thromboembolic disorder
  • Autoimmune disorders limited to
    • Polyarteritis nodosa
    • Polymyalgia rheumatica
    • Polymyositis
    • Rheumatoid arthritis
    • Systemic lupus erythematosus

If you have questions about if you or a loved one may be eligible for a C-SNP, the team at Seniorstar can help! Give us a call today for no-cost coverage consultation.

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