Chronic Condition
Special Needs Plan

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What are Chronic Condition Special Needs Plans?

Chronic Condition Special Needs Plans (C-SNPs) are a type of Medicare Advantage plan. They are designed to meet the medical needs of individuals with chronic or severe conditions and provide coordinated care.

Who is Eligible for C-SNP Medicare Advantage Plans?

C-SNP qualifications include enrollment in Medicare Parts A and B and a diagnosis with at least one of the following:

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  • Chronic alcohol and other dependence
  • Autoimmune disorders
  • Cancer (excluding pre-cancer conditions)
  • Cardiovascular disorders
  • Chronic heart failure
  • Dementia
  • Diabetes mellitus
  • End-stage liver disease
  • End-Stage Renal Disease (ESRD) requiring dialysis (any mode of dialysis)
  • Severe hematologic disorders
  • Chronic lung disorders
  • Chronic and disabling mental health conditions
  • Neurologic disorders
  • Stroke

Not all C-SNPs cover all conditions. For example, one Chronic Condition Special Needs Plan may only cover individuals with heart disease. To meet those specific needs, the plan network may include more cardiologists, common prescriptions may be in the plan formulary, etc.

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What’s Covered by a Chronic Condition Special Needs Plan?

Because each condition requires a unique benefits set, Chronic Condition Special Needs Plans may look very different. In general, you can expect them to have a network including relevant specialists, prescription drug coverage, and additional support beyond what you may have found in other health insurance. The copays associated with certain providers or treatments related to your chronic condition may be reduced. Many C-SNPs will also have care coordinators who work to ensure your providers are all on the same page.

How Do I Get a C-SNP Medicare Advantage Plan?

  • If you think you meet the C-SNP qualifications, you can speak with a licensed insurance agent to review available plans in your area. A licensed insurance agent can review the plan’s benefits and costs with you, as well as check to see whether your providers are part of the plan network.

  • When you enroll in a C-SNP, you may have a limited period of time to provide documentation of your condition to the plan provider. You will need to obtain this documentation from your doctors.

  • Enrollment in C-SNP Medicare Advantage Plans is not open at all times. You may be eligible to enroll right now if you have recently enrolled in Medicare Parts A and B, if the Medicare Annual Enrollment Period is open, or if you have recently lost coverage of some type. A licensed insurance agent can also assist you in figuring out whether you’re eligible to enroll in a Chronic Condition Special Needs Plan right now.


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Enrollment Eligibility

Annual Enrollment Period (AEP)

Medicare Annual Enrollment Period runs each year from October 15 to December 7. What is the Annual Enrollment Period vs. Open Enrollment Period?

Initial Enrollment Period (IEP)

Your Initial Enrollment Period generally surrounds your 65th birthday but may occur if you otherwise become eligible for Medicare for the first time.

Special Enrollment Period (SEP)

You may be eligible if you experience a qualifying life event such as moving to a new zip code, losing employer coverage, or change in Medicaid status.

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Last Updated: October 13, 2023