Do you qualify for a Chronic Special Needs Plan (C-SNP)? 

Millions of people have chronic conditions that may qualify them for a Medicare Advantage Special Needs Plan, but only a small percentage are currently enrolled in a C-SNP. According to the Kaiser Family Foundation, more than 32 million people are enrolled in a Medicare Advantage plan, about half of the country’s Medicare-enrolled population. Of those enrolled in an MA, approximately 6.6 million are enrolled in a Special Needs Plan. 

There are three types of Special Needs Plans:

• C-SNP for chronic conditions
• D-SNP for dual eligibles in Medicare and Medicaid
• I-SNP for those living in institutions 

Only about 660,000 people are enrolled in a Special Needs Plan for chronic conditions.  

Are you missing out by not enrolling in a C-SNP? If you qualify, a C-SNP may be able to help manage your care better and lower your out-of-pocket costs. 

Why enroll in a C-SNP?

Special Needs Plans cater to patients with a specific chronic condition, such as chronic heart failure. A C-SNP may provide you with a personalized care team, affordable drug coverage that includes the most commonly prescribed medications for your condition, and extra services and supplies that may lower your healthcare expenses.

If you’ve been diagnosed with a chronic condition that’s covered by a C-SNP, you may want to consider your options. 

What conditions are covered by C-SNPs?

The Centers for Medicare & Medicaid Services (CMS) has approved 15 C-SNP chronic conditions. The most common C-SNPs are for patients with cardiovascular disorders and/or diabetes. Other chronic conditions commonly included in Special Needs Plans are:

• Chronic lung disorders
• ESRD (end-stage renal disease)
• Dementia
• HIV/AIDS
• Chronic heart failure

Fewer plans address other CMS-approved chronic conditions, such as cancer, stroke, neurological disorders, and alcohol and/or drug dependence.  

Do you qualify for a C-SNP?

Total C-SNP enrollment has grown over the past few years. In 2024, there are 322 C-SNPs on the market for those who are eligible. In order to qualify, you have to be enrolled in Medicare Part A and Part B. You have to be diagnosed with the specific disease or condition covered by a C-SNP, and live within the plan’s service area. 

Enrolling in a C-SNP

If you’ve been diagnosed with a disease or chronic condition that is covered by a C-SNP, you may be eligible to switch plans outside of Open Enrollment. If you have a qualifying condition that is served by a C-SNP in your area, you may be eligible for a Special Enrollment Period.