What is a Medicare Advantage Chronic Condition Special Needs plan (C-SNP)?  

A C-SNP, or a Chronic Condition Special Needs Plan, is a type of Medicare Advantage plan that supports people with one or more eligible chronic conditions. The plan’s benefits emphasize coordinated care and lower costs, making it easier for people to get the help they need.   

 

 

What are the benefits of a C-SNP?  

C-SNPs are usually offered as either a Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) plan. These types of plans will have a connected network of providers that may offer specific services and expertise for people with chronic conditions.  

Like a D-SNP, a C-SNP is required to offer Part D coverage for prescription drugs. C-SNP drug coverage may offer you more coverage for drugs necessary for your chronic condition.

 

Am I eligible for a C-SNP?  

To qualify for a C-SNP, you must be enrolled in Medicare Parts A and B. 

You may be eligible for Medicare if you are a US citizen or permanent legal resident for the last five years. You must also be one of the following:  

• You are age 65 or older 
• You have received Social Security Disability Insurance (SSDI) benefits for at least 24 months
• You have Amyotrophic Lateral Sclerosis (ALS, also called Lou Gehrig’s disease)
• You have End‑Stage Renal Disease (ESRD), meaning permanent kidney failure requiring dialysis or a transplant

In addition, you must have a qualifying chronic condition approved by the Centers for Medicare & Medicaid Services (CMS) and verified by your doctor. A C‑SNP that is designed for your specific condition (or group of conditions) must also be available in your service area. 

Examples of qualifying condition categories include: 

• Chronic alcohol and other drug dependence 
• Certain autoimmune disorders (as defined by CMS) 
• Cancer (excluding pre‑cancer conditions) 
• Certain cardiovascular disorders 
• Chronic heart failure 
• Dementia 
• Diabetes mellitus 
• End‑stage liver disease 
• End‑stage renal disease (ESRD) 
• Severe hematologic disorders 
• HIV/AIDS 
• Certain chronic lung disorders 
• Certain chronic and disabling mental health conditions 
• Certain neurologic disorders 
• Stroke

For details on which conditions are limited or to simply see the full updated list of qualifying chronic conditions, visit the Centers for Medicare & Medicaid Services. 

 

How can I enroll in a C-SNP?  

You can enroll in a C-SNP during several enrollment windows. If you are already eligible for a C-SNP plan during your Initial Enrollment Period (IEP), you can enroll then. This is the time when you first turn 65 and become eligible for Original Medicare. This is a 7-month window beginning 3 months before your 65th birthday, the month of your birthday, and three months after. If you were born on the 1st of the month, the enrollment period begins 4 months before your 65th birthday and ends 2 months after your birthday month.

If you are diagnosed with a qualifying chronic condition, you may qualify for a Special Enrollment Period (SEP) that allows you to enroll in a C‑SNP outside of the standard enrollment periods. In many cases, this SEP is available once you are diagnosed and may last until you enroll in a plan. You may also qualify for other SEPs throughout the year depending on your circumstances.

Read more about Special Enrollment Periods

To enroll in a Medicare Advantage C-SNP, contact the private insurance company of your choice or call a licensed sales agent who can help you through the process. You should also get a Verification of Chronic Condition form completed by your doctor or a specialist who can confirm your eligible qualifying condition within 60 days of submitting your enrollment.