What is a Chronic Special Needs Plan?

Larry Hurwitz Advice, Announcement, Lifestyle

A Chronic Special needs plan or C-SNP is a plan that restricts enrollment to individuals with specific severe or disabling chronic conditions. Currently, CMS (center for Medicare and Medicaid Services) has approved fifteen C-SNP-specific chronic conditions that are eligible for enrollment.

If I qualify, what would be the advantage of enrolling?

These plans are designed to offer maximum coverage targeted as specific chronic conditions such as diabetes and cardiovascular disorders. Several carriers in California offer C-SNP plans. Since these are Medicare Advantage plans, availability is based upon the county you reside in. Los Angeles, Kern, and Orange County provide zero premium plans that cover important benefits for diabetics such as glucose meters, test strips, and podiatry without a copayment.

Patients dealing with diabetes and/or cardiovascular disease will appreciate the following:

  • Prescription drug coverage
  • 32 one-way trips to plan approved locations every year
  • A personal case manager to coordinate your care

Why not stay on original Medicare or a regular Medicare Advantage Plan?

Original Medicare offers excellent flexibility. However, unless you enroll in a Medicare supplement and a prescription drug plan, you are going to be paying a significant out of pocket costs.

Moreover, if you enroll in the best Medicare supplement, Plan “F,” your premium will be about $200/month if you are 69-70 years old, and Medicare does not cover prescriptions, so you will still need to buy a prescription drug plan.

If you only have Medicare, there’s significant cost sharing:

  • $1,288 Part A hospital deductible
  • $166 Part B Medical deductible in addition to your 20% Part B co-insurance

If your doctor doesn’t accept Medicare assignment, add another 15% and remember there is no point that Medicare will pay 100%, regardless of much you might have paid out of pocket. If the premium of purchasing a Medicare supplement and prescription drug plan to coordinate with original Medicare isn’t going to affect your lifestyle then this might be a sensible solution.

On the other hand, going with Original Medicare may not be the sensible solution if the out of pocket costs will dissuade you from going to the doctor. According to the American Diabetes Association, patients with low out of pocket fees saw their doctors more, which enhanced their lives, especially those living with chronic conditions. Furthermore, according to a Rand study, those with hypertension and paying high deductibles saw their physician about a third less, and had higher blood pressure.

C-SNP Medicare Advantage plans unlike traditional Medicare advantage plans are designed for members dealing with specific chronic conditions. For example, most Medicare Advantage plans require the member to pay 20% of the Medicare-allowed amount for durable medical equipment such as wheelchairs and oxygen whereas many C-SNP plans pay 90% so that the member only pays 10% until he/she satisfies their maximum out of pocket, at which point 100% will be covered.

CMS has deemed C-SNP plans worthy of an all year Special Enrollment Period so you can enroll anytime*

SEP’s are generally only available if:

  • You move out of your plans service area
  • You have Medicaid
  • You qualify for Extra Help
  • You live in an institution
  • You lose your employers group health coverage

Verification of your condition is a requirement for qualification. Our agency can make the process effortless between the doctor and the insurance carrier. Call us to see if there are any C-SNP plans available in your county and let us help you find the best one based on your doctors and prescriptions.

Sources:

https://www.medicare.gov/sign-up-change-plans/medicare-health-plans/medicare-advantage-plans/special-needs-plans.html

https://www.cms.gov/Medicare/Health-Plans/SpecialNeedsPlans/ChronicConditionSNP.html