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- What is a Chronic Condition Special Needs Plan (C-SNP)?
What is a Chronic Condition Special Needs Plan (C-SNP)?
If you’re living with a long-term health condition, a C-SNP might be right for you.
By Devoted Health Team
January 9, 2025
So, you’re ready to sign up for Medicare and you’re looking for a plan — and you keep seeing something called a “C-SNP.” Should you be considering a C-SNP? Is it something that could work for your healthcare needs? Let’s find out!
A Chronic Condition Special Needs Plan (C-SNP) is a type of Medicare Advantage plan. C-SNPs are designed for anyone who is eligible for Medicare and living with a long-term health condition such as diabetes or chronic heart failure.
If this sounds like your situation, a C-SNP (pronounced “C-SNIP”) could be especially helpful to you. A C-SNP could get you easier access to specialized care, along with extra benefits and services — like help with coordinating medical specialists, mental health specialists, inpatient facilities, and outpatient facilities. You might also have lower specialist copays.
Prescription coverage is also included in a C-SNP, so you don’t have to sign up for a separate prescription plan (known as Medicare Part D).
Depending on the plan, a C-SNP could also connect you with a care team for help with tackling your health to-dos! After all, managing life is busy enough, on top of keeping track of labs, diagnostic tests, and medications.
Note: C-SNPs do vary from company to company, and benefits can differ depending on the chronic condition. You'll need to check directly with a plan provider to see if they offer a C-SNP that meets your specific healthcare needs.
What’s the difference between a C-SNP and a D-SNP?
The two SNPs you’ll probably hear about most often are Chronic Condition Special Needs Plans (C-SNPs) and Dual Eligible Special Needs Plans (D-SNPs). Both types of SNPs can be HMO or PPO Medicare Advantage plans.
But here’s how they’re different:
C-SNPs are designed for people with specific chronic or disabling conditions.
A C-SNP might be the best choice if you have a long-term health condition such as:
- Diabetes
- Heart disease
- Autoimmune disorders
D-SNPs are designed for people who are eligible for both Medicare and Medicaid.
If you qualify for Medicare and Medicaid, you’re considered to be “dual-eligible.”
When you have dual eligibility, you can enroll in a D-SNP and get coverage that combines Medicare and Medicaid services.
How do I know if I’m eligible for a C-SNP?
You must already have Medicare Parts A and B (Original Medicare) to qualify for a C-SNP. Haven’t signed up for Medicare yet? Get started by checking to see if you meet the eligibility requirements.
To qualify for a C-SNP, you must also:
- Be a U.S. citizen or lawfully present in the U.S.
- Live in an area where C-SNPs are available
- Have a serious or disabling chronic condition listed for your state
- Get a doctor to verify your eligibility (this requirement can vary by plan)
Which chronic conditions are covered by C-SNPs?
A chronic condition is a long-term health condition that lasts 1 or more years.
Currently, there are 15 specific chronic conditions that qualify you for a C-SNP, per the Centers for Medicare & Medicaid Services (CMS). Some of these conditions include:
- Heart disease
- Diabetes
- Cancer
- Chronic lung disorders
- End-stage liver disease
- Dementia
- Certain severe hematologic disorders
- Stroke
Note: Depending on the C-SNP, a doctor may need to fill out a Chronic Condition Verification Form for the plan’s provider to ensure eligibility.
What benefits do C-SNPs offer?
C-SNPs typically offer:
Original Medicare Part A benefits
This includes coverage for hospital stays, skilled nursing facility care, hospice care, some home health care, and wellness programs.
Original Medicare Part B benefits
This includes coverage for doctors’ services, outpatient care, durable medical equipment, and preventive services, like exams and lab tests.
Original Medicare Part D benefits
This is optional insurance for drug coverage that can be added to Original Medicare (Parts A and B). It’s usually included with a Medicare Advantage Plan (Part C).
C-SNPs may also include extra benefits not covered by Original Medicare.
- C-SNPs may also include dental, vision and hearing coverage as well as fitness-related benefits.
- If you have a serious illness that requires hospitalization (such as cancer or congestive heart failure), a C-SNP might also cover extra days in the hospital.
What out-of-pocket costs can I expect with a C-SNP?
Medicare Advantage plans like C-SNPs are offered by private insurance companies. This means costs like premiums and deductibles for C-SNPs can vary. However, for certain services — such as chemotherapy, dialysis, and skilled nursing facility care — you can’t be charged more than what they’d cost with Original Medicare.
The key to lowering healthcare costs on a C-SNP is to stay in-network:
You can keep your out-of-pocket costs lower by visiting doctors, pharmacies, and hospitals that are in your plan’s network (versus going outside of the network).
Out-of-pocket costs include:
- Copays
- Coinsurance
- Deductibles for doctor visits, hospitalization, and drug coverage
When can I enroll in a C-SNP?
C-SNP enrollment falls into a Medicare enrollment category known as a Special Enrollment Period. So, if you’re newly diagnosed or have a worsening condition that makes you eligible for a C-SNP, you don’t have to wait for specific Medicare enrollment periods to join a plan. You can sign up at any time.
Of course, you also have the option to sign up during specific Medicare enrollment periods:
Initial Enrollment Period
If you’re newly qualified for Medicare due to age, initial enrollment begins 3 months before your 65th birthday and ends 3 months after your 65th birthday, for a total of 7 months (or 4 months before and 2 months after if your birthday is on the first day of the month).
If you’re newly qualified for Medicare due to disability, initial enrollment begins 3 months before the 25th of the month you receive either Social Security or Railroad Retirement Board disability benefits. This enrollment period lasts for 7 months.
Annual Enrollment Period
The Annual Enrollment Period (AEP) takes place each year from October 15 to December 7. During this time, you can switch from your current C-SNP to another plan or enroll for the first time. You can also disenroll from a plan during this time.
What should I keep in mind when signing up for a C-SNP?
Enrolling for a C-SNP can be an important and helpful step when living with and managing a chronic condition. But make sure you’re choosing the right C-SNP.
Take the time to evaluate your personal situation and needs, then research your options. That way, you can make an informed choice and get the best healthcare experience.
When deciding on a C-SNP:
- Compare plan options, and pay close attention to benefits.
- Understand details around premiums, copays, and out-of-pocket costs.
- Find out if the plan offers the help you need with personalized care management.
- Make sure the plan covers your prescribed medications.
- Decide if the plan fits your budget and if it’s a good value overall.
How Devoted Health can help
Call us at 1-800-483-8066 (TTY 711) for personalized assistance.
You can also learn more about your Medicare options in this free Medicare Comparison Guide.