What Is a Chronic Condition Special Needs Plan (CSNP)?
Key Takeaways
- C-SNPs are a type of Medicare Advantage (Part C)Medicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). plan.
- To be eligible for a C-SNP, you must also be eligible for Medicare.
- C-SNPs are designed to provide people with chronic or debilitating illnesses the medical care and treatments they need, all in one plan.
- C-SNPs always include prescription drug coverageMedicare Part D is prescription drug coverage for people enrolled in Medicare. Part D is optional and is offered by private insurance companies. (Medicare Part D).
A Chronic Condition Special Needs Plan (C-SNP, or CSNP) is a Medicare Advantage plan type that serves people with severe chronic health conditions. A CSNP offers specialized care to treat and manage long-term conditions such as congestive heart failure, diabetes, substance dependence, and chronic obstructive pulmonary disease (COPD).
CSNP coverage requires beneficiaries to meet specific criteria. These plans offer more tailored benefits that can better serve eligible beneficiaries than standard Medicare Advantage plans.
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Medicare Advantage at a Glance
According to KFF, 32.8 million people enrolled in Medicare Advantage plans in 2024 — more than half of all Medicare enrollments. These plans, also called Medicare Part C, are managed by private insurance companies approved by Medicare. All Medicare Advantage plans cover the same benefits as Original Medicare (Parts A and B) at minimum, though many also offer extended benefits. For example, Medicare Advantage plans may cover prescription drugs through bundled Part D benefits or offer vision and dental coverage.
Special Needs Plans (SNP) function like other Medicare Advantage plans by providing Part A and Part B benefits, plus extras. However, the extra benefits of SNPs cater to specific demographics. For example, C-SNPs offer additional benefits that relate directly to treating and managing chronic conditions.
Understanding C-SNP Medicare Plans
Chronic Condition Special Needs Plans are for Medicare beneficiaries who need specialized medical care from living with a qualifying condition. Here’s what you should know to determine whether a C-SNP plan is right for you.
Key Features of Medicare CSNPs
- Covers targeted care to meet the specific needs of individuals with any of 15 eligible chronic health conditions
- Includes coordinated care teams to manage beneficiaries’ specific health needs
- Offers prescription drug coverage
- Provides access to a network of providers who specialize in managing chronic health conditions
CSNP Eligible Chronic Conditions
- Autoimmune disorders limited to polyarteritis nodosa, polymyalgia rheumatica, polymyositis, rheumatoid arthritis, and systemic lupus erythematosus
- Cancer, not including in-situ or pre-cancer conditions
- Cardiovascular disorders limited to cardiac arrhythmias, chronic venous thromboembolic disorder, coronary artery disease, and peripheral vascular disease
- Chronic and disabling mental health conditions limited to bipolar disorders, major depressive disorders, paranoid disorder, schizoaffective disorder, and schizophrenia
- Chronic dependence on alcohol or other drugs
- Chronic heart failure
- Chronic lung disorders limited to asthma, chronic bronchitis, emphysema, pulmonary fibrosis, and pulmonary hypertension
- Dementia
- Diabetes mellitus
- End-stage liver disease
- End-stage renal disease (ESRD) if it requires dialysis
- HIV/AIDS
- Neurologic disorders limited to amyotrophic lateral sclerosis, epilepsy, extensive paralysis, Huntington’s disease, multiple sclerosis, Parkinson’s disease, polyneuropathy, spinal stenosis, and stroke-related neurologic deficit
- Severe hematologic disorders limited to aplastic anemia, hemophilia, immune thrombocytopenic purpura, myelodysplastic syndrome, and sickle-cell disease (excluding sickle-cell trait)
- Stroke
All potential SNP enrollees must have Medicare Parts A and B and live in the service area of their desired plan. To enroll in a C-SNP, you’ll also need documentation from your doctor confirming that you’ve been diagnosed with at least one of the conditions listed above. Enrollees typically need to verify their C-SNP eligibility annually.
What Does a Medicare C-SNP Cover?
Like all Medicare Advantage plans, C-SNPs include Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). All C-SNPs also offer Medicare Part D (prescription drug insurance) to help beneficiaries manage their conditions. CSNP plans may also cover:
- Dental, vision, and hearing care
- A personal care team
- Lower copays for some specialized medical providers
- Over-the-counter health and wellness items
- Transportation to relevant medical appointments
- Nutritional education and coaching
- Fitness programs
- Necessary medical supplies and equipment
- Foods tailored to a nutrition plan
Specific additional benefits beyond Parts A, B, and D vary by plan carrier, though in general, C-SNPs are tailored to manage each beneficiary’s unique condition.
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Costs vary among Medicare Advantage plans, including C-SNPs, depending on each beneficiary’s location, plan type, and the additional benefits offered.
- Premiums: You must pay a monthly premium fee to keep your Medicare Advantage plan active. The Centers for Medicare and Medicaid Services estimate that the average Medicare Advantage premium costs $17 in 2025, though plan premiums will vary. You must also pay the Medicare Part B premium ($185 per month in 2025).
- Deductibles: Most insurance plans require beneficiaries to meet a predetermined deductible before the plan’s coverage kicks in. However, many C-SNPs have $0 deductibles to help beneficiaries seek necessary care faster.
- Copays: A copay is a flat fee you pay out of pocket for medical services every time you see a doctor or a specialist. Depending on your plan, copays range from $10 to $100. Insurance providers set their own copays for C-SNP plans.
- Coinsurance: Coinsurance functions similarly to copays, but instead of charging a flat fee per health visit, you’ll pay a fixed percentage of the visit’s cost. For example, your plan may cover 80% of a doctor’s visit cost while you pay the remaining 20% out of pocket.
See It in Action
Let’s say you receive a diagnosis for diabetes, which costs around $12,000 per year out of pocket (OOP) to manage, according to the American Diabetes Association. You enroll in a C-SNP to help cover the costs associated with your treatment. Your plan offers a personalized care team to help manage your condition. It also covers supplies and charges relatively low copays for specialist visits.
Here’s how your C-SNP might impact your costs of care, though exact costs and coverage amounts vary:
| Care | Cost Without C-SNP | Cost With C-SNP |
|---|---|---|
| Diabetes testing supplies | Glucose meter: $28, test strips (pack of 90): $50 | Glucose meter: $0, test strips (pack of 90): $0 |
| Endocrinologist checkup | $100 OOP | $35 copay |
| Monthly supply of insulin | $1,250 ($250 per vial) OOP | $35 copay |
| Medical nutrition therapy | $100 OOP | $0 copay |
| Diabetes self-management training | $200 OOP | $0 copay |
| Therapeutic shoe inserts | $150 OOP | $30 (20% coinsurance) |
All costs listed in the example are hypothetical to help illustrate how a CSNP may impact health costs. Your actual costs for treatment, medication, and out-of-pocket costs will vary.
How a C-SNP Compares With Other Special Needs Plans
| C-SNP | D-SNP | I-SNP | |
|---|---|---|---|
| Name | Chronic Condition Special Needs Plan | Dual Eligible Special Needs Plan | Institutional Special Needs Plan |
| Who it’s for | Those with a qualifying chronic condition | Those eligible for both Medicare and Medicaid | Those living in a long-term care facility |
| Part A | Included | Included | Included |
| Part B | Included | Included | Included |
| Part D | Included | Included | Included |
| Medicaid coordination | No | Yes | No |
| Condition care management | Yes | No | Yes |
How To Choose a C-SNP
When deciding on a C-SNP, evaluate your health status and needs. What types of specialized care will you require for your chronic health condition? Do you have multiple chronic health conditions for which you’ll need to manage treatment?
Your chosen plan should offer specialized care coordinators to help manage your specific condition(s) in the long term. CSNP benefits also typically help pay for supplies, screenings, treatments, and management programs relevant to your health status.
Once you’ve determined which C-SNP offers the most appropriate coverage for your healthcare needs, evaluate the options in your specific location. Not all C-SNPs are available in all regions. Ensure your chosen plan’s network includes medical providers and facilities where you live.
Choose a plan that aligns with your budget regarding premium prices, deductibles, coinsurance, copays, and prescription drug coverage. From there, speak with your medical providers to gather any documentation required to prove your eligibility for a C-SNP. Once you’ve chosen a plan and verified your eligibility, enroll either directly with the insurance carrier or work with a licensed insurance agent or broker.
CSNP Enrollment Periods
Receiving a diagnosis for a chronic health condition that qualifies you for a C-SNP triggers a Special Enrollment Period (SEP), during which you can enroll in a C-SNP at any point. This SEP typically lasts 60 days from the day of your diagnosis.
Alternatively, you can enroll in a C-SNP during these other enrollment periods:
- Initial Enrollment Period: This seven-month period starts three months before your 65th birthday and ends three months after your birthday month. If you meet the eligibility criteria during this time, you may enroll in a CSNP right away.
- Annual Enrollment Period: The Annual Enrollment Period runs from October 15 to Decemeber 7 every year. This enrollment window is your chance to join a Medicare or Medicare Advantage plan, including a CSNP outside of your Initial Enrollment Period or your diagnosis SEP.
- Medicare Advantage Open Enrollment Period: This period runs from January 1 to March 31 each year. It differs from the Annual Enrollment Period in that it is only open to those already enrolled in a Medicare Advantage plan. If you currently have a Medicare Advantage plan, you may switch to a CSNP during this time, or from one CSNP to another.
Putting It All Together
If you manage a severe chronic health condition, you may be eligible for a Chronic Condition Special Needs Plan, or a C-SNP. This type of Medicare Advantage plan offers personalized, coordinated care to help pay for the long-term treatment and management of your condition.
Proving your C-SNP eligibility and selecting and enrolling in a plan can be a complex and confusing process. Consider working with a licensed insurance agent or broker to ensure you choose the best plan for your budget and health requirements.
Sources
- Medicare Advantage in 2024: Enrollment Update and Key Trends. KFF.
- Medicare Advantage and Medicare Prescription Drug Programs to Remain Stable as CMS Implements Improvements to the Programs in 2025. CMS.gov.
- Economic Costs of Diabetes in the U.S. in 2022. American Diabetes Association.
- Cost of endocrinologist visit by state. Sidecar Health.