Chronic Condition Special Needs Plans (C-SNPs)

Chronic Condition Special Needs Plans, also known as C-SNPs, are specialized Medicare Advantage plans designed for people with certain qualifying chronic health conditions.

C-SNPs may be available to Medicare beneficiaries with conditions such as:

Diabetes
Heart disease or cardiovascular disorders
Chronic lung disorders, including COPD
Disabling mental health conditions
End-Stage Renal Disease (ESRD)
Chronic kidney disease
HIV/AIDS
Certain neurologic disorders
Other severe or disabling chronic conditions

Plan availability depends on your county, the insurance carrier, and the specific chronic condition the plan is designed to serve.

Elderly woman reading paper with assistance.

Doctor consulting with elderly patient at home.

How C-SNP Plans Work

C-SNPs are Medicare Advantage plans that tailor their benefits, provider networks, care coordination services, and prescription drug formularies to better meet the needs of people with specific chronic conditions.

These plans may offer additional support, such as:

Care coordination
Disease management programs
Access to certain provider groups
Prescription drug coverage
Benefits designed around specific chronic health needs

Do C-SNP Plans
Cover Prescription Drugs?

Yes. All Medicare Special Needs Plans must include Medicare Part D prescription drug coverage.

However, each plan has its own formulary, which is the list of covered medications. Before enrolling, it is very important to confirm that your prescriptions are covered by the plan and that your preferred pharmacy participates.

Extra Benefits May Be Available

Some Chronic Special Needs Plans may offer enhanced benefits such as:

Grocery allowances
Utility assistance
Over-the-counter benefits
Prepaid debit card allowances
Dental, vision, and hearing benefits
Transportation benefits
Fitness or gym memberships

Several plans may offer prepaid debit cards with monthly allowances, sometimes ranging from approximately $100 to $200, depending on the plan, county, and eligibility.

C-SNPs for Medicare and
Medi-Cal Beneficiaries

If you have both Medicare and Medi-Cal and are considered Full Benefit Dual Eligible (FBDE), also known as “Medi-Medi” in California, you may be especially interested in these plans.

Many full-benefit Medi-Cal beneficiaries automatically qualify for Full Extra Help/LIS, which can significantly reduce or eliminate prescription drug costs.

In many cases, Medi-Cal may also help pay Medicare cost sharing, which means your out-of-pocket costs for covered services may be very low or possibly $0. However, this depends on your Medi-Cal status, plan rules, provider network, and whether your prescriptions are covered.

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Important Warning if You Do Not Have Medi-Cal

If you are not a Medi-Cal beneficiary, be careful before enrolling in a C-SNP.

Some C-SNPs are designed for people who have both a chronic condition and Medi-Cal. Choosing the wrong plan could result in higher copays, more out-of-pocket costs, or limited provider access.

Before enrolling, we can help you review:

Whether you qualify for the C-SNP
Whether your doctors accept the plan
Whether your prescriptions are covered
What your copays and out-of-pocket maximum may be
Whether you qualify for Medi-Cal, Extra Help, or other assistance programs

Need Help Comparing C-SNP Plans?

Choosing the right Medicare Advantage or C-SNP plan can be confusing. We can help you compare available plans in your county and review your doctors, prescriptions, chronic conditions, and Medi-Cal status.