Chronic Condition Special Needs Plans (C-SNPs) in California
If you have Medicare and are living with certain chronic health conditions, you may qualify for a specialized Medicare Advantage plan known as a Chronic Condition Special Needs Plan, or C-SNP.
C-SNPs are designed around the healthcare needs of people with specific chronic conditions. Depending on the plan and where you live, they may provide specialized provider networks, prescription drug coverage, care coordination, disease management programs, and additional benefits not available through Original Medicare alone.
Qualifying conditions may include:
- Diabetes
- Heart disease and certain cardiovascular disorders
- Chronic lung disorders, including COPD
- End-Stage Renal Disease (ESRD)
- Chronic kidney disease
- HIV/AIDS
- Certain disabling mental health conditions
- Certain neurologic disorders
- Other severe or disabling chronic conditions
Eligibility requirements vary by plan, and not every C-SNP is available in every California county.
How Do C-SNP Medicare Plans Work?
C-SNPs are Medicare Advantage plans specifically designed for beneficiaries with certain qualifying chronic conditions.
Unlike a general Medicare Advantage plan, a C-SNP may tailor its provider network, prescription drug formulary, care coordination, and other services around the particular healthcare needs of the population it serves.
Depending on the plan, benefits may include:
- Care coordination
- Disease management programs
- Access to certain doctors, specialists, hospitals, and medical groups
- Medicare Part D prescription drug coverage
- Benefits and services designed around specific chronic health needs
Before enrolling, it is important to look beyond the additional benefits and make sure the plan works with your doctors, hospitals, prescriptions, and overall healthcare needs.
Do C-SNP Plans
Cover Prescription Drugs?
Yes. Medicare Special Needs Plans include Medicare Part D prescription drug coverage.
However, every plan has its own formulary, which is the list of medications covered by the plan. Copays, pharmacy networks, prior authorization requirements, and coverage rules can also vary.
Before enrolling in a C-SNP, we recommend checking each of your prescriptions—including the exact medication, dosage, and frequency—to make sure they are covered appropriately.
What Additional Benefits Can C-SNP Plans Offer?
Depending on the plan, county, qualifying condition, and eligibility requirements, some C-SNPs may offer additional benefits such as:
- Grocery or healthy-food allowances
- Utility assistance
- Over-the-counter allowances
- Prepaid debit card benefits
- Dental coverage
- Vision benefits
- Hearing benefits
- Transportation assistance
- Fitness or gym memberships
- Additional care coordination
These benefits can be valuable, but they vary significantly from one plan to another and may have additional eligibility requirements.
A plan offering a large allowance or attractive additional benefits isn't necessarily the best plan for you if your doctors aren't in the network, your prescriptions aren't covered appropriately, or your medical copays are higher.
C-SNPs for People With Medicare and Medi-Cal
If you have both Medicare and Medi-Cal, your options may be different.
Some people with qualifying chronic conditions may be eligible for a C-SNP, while others may qualify for a Dual Eligible Special Needs Plan (D-SNP) or a Medi-Medi Plan designed specifically to coordinate Medicare and Medi-Cal benefits.
Full-benefit Medi-Cal beneficiaries may also qualify for Extra Help (Low-Income Subsidy/LIS) with Medicare prescription drug costs. Depending on your Medi-Cal eligibility and plan, Medi-Cal may also help with Medicare premiums and cost sharing.
Learn more about Low or No-Cost Medicare Options in California.
Important Considerations If You Don't Have Medi-Cal
You do not necessarily need Medi-Cal to qualify for a C-SNP. Eligibility is generally based on having Medicare and a qualifying chronic condition that meets the requirements of the particular plan.
However, this is where comparing plans becomes especially important.
Some plans and additional benefits may be particularly advantageous for people who also have Medi-Cal or qualify for certain assistance programs. If you don't have Medi-Cal, your copays, coinsurance, maximum out-of-pocket exposure, and eligibility for certain supplemental benefits may be different.
Before enrolling, we can help you determine:
- Whether your chronic condition qualifies for the C-SNP
- Whether your doctors and specialists participate
- Which hospitals and medical groups are available
- Whether your prescriptions are covered
- Your copays and maximum out-of-pocket exposure
- Which additional benefits you actually qualify for
- Whether you may qualify for Medi-Cal, Extra Help, or another assistance program
When Can You Enroll in a C-SNP?
One advantage of qualifying for a Chronic Condition Special Needs Plan is that you may be eligible for a Special Enrollment Period (SEP) rather than having to wait for Medicare's Annual Enrollment Period.
Your ability to enroll or change plans depends on your individual circumstances and Medicare eligibility.
If you have recently been diagnosed with a qualifying chronic condition, are losing other coverage, have moved, or have had another change in circumstances, we can help determine whether you have an enrollment opportunity.
Choosing a C-SNP in California
C-SNP availability varies considerably by county.
The right plan isn't necessarily the one with the largest grocery allowance, lowest advertised premium, or longest list of additional benefits.
We start with the big picture—your chronic condition, doctors, specialists, hospitals, medical groups, prescriptions, current coverage, Medi-Cal status, budget, and what matters most to you.
From there, we can compare the C-SNP and other Medicare Advantage options available in your California county and help you understand the differences before you enroll.
Carriers We Represent
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Anthem Blue Cross (Elevance)
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Aetna
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Alignment Health Plan
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Beam
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Blue Shield of CA
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Cigna
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Delta Dental
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Health Net
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HealthSpring
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Humana
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Kaiser
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Imperial Health Plan of California
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LA Care
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Medico/Wellabe
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Molina
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SCAN
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Sutter Health
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UCLA Health Medicare Advantage
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United Concordia
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UnitedHealthcare / AARP
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VSP
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WellCare / Centene
Need Help Comparing C-SNP Plans?
Speak With a Local Medicare Expert
Choosing the right C-SNP can help you:
- Coordinate care for your chronic health condition
- Make sure your doctors participate in the plan
- Confirm your prescriptions are covered
- Understand your copays and additional benefits
We’ll help you compare C-SNP plans available in your county and find the best fit for your individual needs.
Call to compare C-SNP Medicare plans available in your area.