Chronic Special Needs Plans

Chronic Special Needs Plans (C-SNPs) are available to those with a qualifying illness. They provide necessary, specific health coverage for your specific treatment.

What is a C-SNP?

C-SNPs are a part of Medicare Advantage, an alternative to Original Medicare. There are 4 other types of Advantage plans besides the C-SNP:

  • Health Maintenance Organization (HMO)
  • Preferred Provider Organization (PPO)
  • Private Fee-For-Service (PFFS)
  • Dual-Eligible Special Needs Plan (D-SNP)

Only the C-SNP and D-SNP, however, have special eligibility requirements apart from the typical Original Medicare requirements. More specifically, C-SNPs only accept and provide coverage for specific conditions and illnesses that are deemed chronic and qualifiable.

Eligibility for a C-SNP

According to the National Center for Biotechnology Information (NCBI), the most common chronic illnesses, regardless of age, in the U.S. are:

  • Diabetes
  • Arthritis
  • Asthma
  • Chronic Kidney Disease
  • Chronic Obstructive Pulmonary Disease
  • General Mental Health Issues
  • Alcoholism

These issues are rampant, and seniors are affected by them especially hard. To compensate for these illnesses and more, Medicare created the C-SNP. You must, then, have one or more of these conditions to qualify for a C-SNP:

  • Stroke
  • Diabetes
  • Alcoholism
  • Drug Abuse/Substance Abuse
  • Alzheimer’s Disease and Related Dementias
  • Heart Failure
  • Arthritis (Osteoarthritis and Rheumatoid)
  • Hepatitis (Chronic Viral B & C)
  • Asthma
  • HIV/AIDS
  • Atrial Fibrillation
  • Hyperlipidemia (High cholesterol)
  • Autism Spectrum Disorders
  • Hypertension (High blood pressure)
  • Cancer (Breast, Colorectal, Lung, and Prostate)
  • Ischemic Heart Disease
  • Chronic Kidney Disease
  • Osteoporosis
  • Chronic Obstructive Pulmonary Disease
  • Schizophrenia and Other Psychotic Disorders
  • Depression

If you may have one of these conditions, you will have to complete what is referred to as a chronic condition verification form. Depending on the plan you purchase, only certain conditions are covered. On the verification form, then, they will ask simple questions regarding the specific illnesses they cover. This is typically as simple as a few checkboxes or fill-in-the-blanks.

These questions, unlike other Medicare plans, are not to disqualify you. Rather, to gain an understanding of the coverage and benefits you need.

Coverage with a C-SNP

C-SNP Medicare coverage is based on your specific needs regarding your chronic condition(s). Say, for instance, you have diabetes. Any necessary insulin injections, insulin pumps, diabetes medications, etc., will all be covered or mostly covered.

Whatever your condition may be, coverage such as prescription drugs and medications, radiation treatments and therapy, and any other specific needs required to keep you feeling safe and happy as you cope with the illness.

Frequently Asked Questions About C-SNPs

Will my C-SNP cover the doctors and specialists I want to see?

Because C-SNPs are a type of Advantage plan, they are loosely structured within a network. Your treatment, then, will be less expensive within this network. However, it is very easy to see a specialist if it is required for your condition.

What are your out-of-pocket costs with a C-SNP? 

With a C-SNP, you will not have to pay the full amount for most of your treatments. However, you will more than likely have some coinsurance or copayment fees, ranging anywhere from a small flat rate to 20% of the total cost.

Are my prescriptions covered under my C-SNP? 

Yes, any necessary prescriptions will more than likely be at least partially covered.

Your Chronic Condition Coverage Matters—Call Iowa Illinois Senior Solutions

Dealing with a chronic illness is difficult, and even more difficult without help with your insurance. Iowa Illinois Senior Solutions can help relieve some of your burden by finding you a C-SNP that will provide the coverage you need—for guidance, advice, or just an extra hand, give us a call at 563-579-6116 or email us at jon@iailsenior.com.

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