Chronic Special Needs Plans
If you suffer from a chronic condition, you may have unique health care needs that are directly related to the symptoms of that condition. Medicare Advantage offers unique Medicare Advantage options to individuals with chronic conditions, in the form of Chronic Special Needs Plans (C-SNP). Here’s what you need to know about what these plans offer their participants.
What Is Medicare Advantage?
Unlike Original Medicare, which is the standard Medicare plan offered publicly to members, Medicare Advantage is a private option that is administered through 3rd party insurance companies. Although the insurers contract with Medicare to provide your benefits, they have fewer limitations on the types of benefits they can offer and how they must be structured. This allows greater flexibility in accessing your Medicare benefits.
What Are Chronic Special Needs Plans
Chronic Special Needs Plans (C-SNPs) are Medicare Advantage plans that only allow individuals with distinctly severe or disabling chronic conditions to enroll. These plans are necessary, because many Medicare recipients have several chronic health conditions and therefore require their health care to be coordinated across several health care providers, including medical and mental health care professionals and the facilities they operate from.
Which Chronic Conditions Qualify For C-SNP Plans?
There are 15 specific conditions that have been approved by the federal government for inclusion in C-SNP plans. The technical qualification for a C-SNP plan is to have one or more complex chronic condition that is disabling or life threatening; have a high risk of hospitalization or other health outcomes; and require delivery systems across domains of care.
These conditions are covered under SNP programs:
- Chronic alcohol and other drug dependence
- Autoimmune disorders
- Cancer
- Cardiovascular disorders
- Chronic heart failure
- Dementia
- Diabetes mellitus
- End-stage liver disease
- End-stage renal disease
- Severe hematologic disorders
- HIV/AIDS
- Chronic lung disorders
- Chronic disabling mental health conditions
- Neurologic disorders
- Strokes
The contents of this list are reviewed regularly and if upon reevaluation it is found that additions will be made, the abiding body will reconsider the contents. This list overall can have exceptions, though it is solely intended to highlight what qualifies you for eligibility a C-SNP policy.