What Are Chronic Condition Special Needs Plans?

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Chronic condition special needs plans (C-SNP) are Medicare Advantage plans designed to treat specific medical conditions, like cancer and diabetes. While all Medicare Advantage plans offer the same basic coverage as Original Medicare, a C-SNP’s additional benefits are designed to make managing chronic conditions easier, including extra hospital days and prescription drug coverage.

Qualifying for a C-SNP

You cannot simply enroll in a C-SNP. You need a doctor’s recommendation first. In addition, C-SNPs are only available for the following conditions.

A C-SNP may be structured around more than one of these categories, if the conditions are clinically linked and commonly comorbid. For instance, many C-SNPs structured around chronic heart failure also treat cardiovascular disorders. 

Once you have a doctor’s approval, you can enroll in a Medicare Advantage chronic condition special needs plan through a licensed insurance agent, like any other Medicare Advantage plan.

What benefits does a C-SNP offer over a regular Medicare Advantage plan?

The biggest advantage of a C-SNP over a traditional Medicare plan is coordination. In a typical Medicare Plan, your primary care physician (PCP) works independently from any specialists you might see.  With a C-SNP, you are assigned a specialist in addition to your PCP, who work in concert to manage your care. Depending on your condition, your care management team will likely involve nursing staff and other healthcare professionals that work with you frequently. This reduces the risk of miscommunication, leading to a smoother experience.

A C-SNP will also offer any additional services, medicine, and equipment deemed necessary to treat your condition. For instance, if you have a chronic lung disorder, your C-SNP will provide ready access to oxygen supplies. This does not mean ordinary Medicare Advantage plans don’t cover oxygen: the C-SNP simply makes them more accessible. You’re also likely to encounter less (if any) cost-sharing when pursuing condition related care, though you are likely to still face cost-sharing measures for medical care unrelated to your condition.

All SNPs, under federal law, must include prescription drug coverage. For C-SNPs, this prescription drug coverage is often tailored to your condition. All prescription drug plans, Medicare or otherwise, have formularies, which refers to the drugs available through said plan. A C-SNP’s formulary prioritizes treating the conditions they focus on. This may mean a wider selection of drugs, or reduced cost-sharing obligations for commonly prescribed drugs. 

Depending on your condition, your C-SNP may also include classes, counciling, and other forms of support.

Are there Downsides to a C-SNP?

SNPs rely on networks to function, so if you’re used to the flexibility of a PPO or Original Medicare, you might be disappointed. The limited network is necessary for Medicare planning, as coordinating with out-of-network providers is difficult. However, you are free to change your Medicare plan each year if an SNP does not work for you.

It should be noted that C-SNPs are not the only kind of SNPs available. You can also enroll in an Institutional SNP (I-SNP), or a Dual Eligible SNP (D-SNP), depending on your unique situation.

If you’re looking for an SNP, want to confirm your eligibility, or just want to understand your options, our licensed insurance agents can help. Give us a call at (800) 950-0608 or enter your zip code into our free comparison tool to begin your search.