What Is a C-SNP?
C-SNPs are a category of SNPs that limit enrollment to individuals that are considered to have a specific special need or chronic condition(s), as defined by the Center for Medicare and Medicaid Services (CMS) and listed in their guidelines as such.
Note: CMS worked with experts and/or clinical advisors to create this list based on common practices and it could change depending on guidance that CMS gets moving forward.
Those that have a chronic condition, or combination of chronic conditions, most likely require their condition and treatment to be monitored and coordinated amongst various health areas like their family doctor, health specialists, and a variety of facilities. A C-SNP could provide better coverage for those who need such care for their chronic condition(s).
You must be enrolled in Medicare Part A and Part B to join a Medicare Advantage plan. Other eligibility requirements are specific to the plan of interest. For example, whether you qualify for a C-SNP mainly depends on what type of chronic condition you have and if it falls within the CMS guidelines. Currently, the guidelines include 15 conditions, which break down to:
- Chronic alcohol and other drug dependence
- Some autoimmune disorders
- Some cancer conditions
- Some cardiovascular disorders
- Chronic heart failure
- End-stage liver disease
- End-stage renal disease (ESRD) requiring dialysis
- Some severe hematologic disorders
- Some chronic lung disorders
- Some chronic and disabling mental health conditions
- Some neurological disorders, and
Eligibility requirements for some of these conditions could be limited to certain disorders. For example, those with an autoimmune disorder, but otherwise have polyarteritis nodosa, polymyalgia rheumatica, polymyositis, rheumatoid arthritis, and systemic lupus erythematosus would not currently qualify for C-SNP. If someone has one of the 15 main conditions, further research should be done to ensure their specific disorder isn’t excluded.
How to Apply
The application process for a C-SNP may involve giving proof of the condition that otherwise qualifies for a C-SNP. Also, applicants would need to apply for the specific plan that they’d like to enroll in. Enrollment is most commonly available during an initial enrollment period, general enrollment, or Fall open enrollment.