Do You Qualify for a Chronic Special Needs Plan (C-SNP)?

• Admin
• 25 Jan 2025

Do You Qualify for a Chronic Special Needs Plan (C-SNP)?

Millions of people live with chronic conditions that could qualify them for a Medicare Advantage Special Needs Plan (SNP)—yet only a small percentage are enrolled in a Chronic Special Needs Plan (C-SNP). According to the Kaiser Family Foundation, over 32 million people are enrolled in Medicare Advantage plans, representing about half of all Medicare beneficiaries. Of those, only around 660,000 are enrolled in a C-SNP.

Types of Special Needs Plans

There are three kinds of Medicare Advantage Special Needs Plans:

• C-SNP: For individuals with qualifying chronic conditions
• D-SNP: For those who are dual-eligible for Medicare and Medicaid
• I-SNP: For individuals living in institutional settings (like nursing homes)

Are You Missing Out?

If you have a qualifying chronic condition, enrolling in a C-SNP could help better manage your care and lower your out-of-pocket costs. These plans are built to serve people with specific health needs and provide:

• Personalized care coordination teams
• Drug coverage that includes commonly prescribed medications
• Extra benefits like transportation, over-the-counter allowances, and wellness support

Conditions Covered by C-SNPs

The Centers for Medicare & Medicaid Services (CMS) has approved 15 chronic conditions for C-SNP coverage. The most commonly served conditions include:

• Cardiovascular disorders
• Diabetes
• Chronic lung disorders (e.g., COPD)
• End-Stage Renal Disease (ESRD)
• Dementia
• HIV/AIDS
• Chronic heart failure

Some plans may also cover conditions like cancer, stroke, neurological disorders, and substance dependence—though these are less common.

Do You Qualify for a C-SNP?

To qualify for a Chronic Special Needs Plan, you must:

• Be enrolled in both Medicare Part A and Part B
• Have a diagnosis for one of the CMS-approved chronic conditions
• Live in the service area of a plan that offers a C-SNP for your condition

In 2024, there are 322 C-SNPs available across various regions of the U.S., and that number may grow as more people explore their eligibility.

When Can You Enroll?

If you meet the criteria for a C-SNP, you can enroll during the Annual Open Enrollment Period (October 15 – December 7). However, if you’re diagnosed with a qualifying condition outside of that timeframe, you may be eligible for a Special Enrollment Period and switch into a C-SNP plan without waiting.

Bottom Line: If you’ve been diagnosed with a chronic condition, it’s worth exploring whether a C-SNP is available in your area. It could help you access better care, reduce your costs, and improve your quality of life.