The Beginner's Guide to C-SNPs

Have you ever considered selling Chronic Condition Special Needs Plans (C-SNPs)? Yes or no, we’ve got the quick guide that you need to read!

C-SNPs can allow health insurance agents to keep selling Medicare Advantage (MA) plans during lock-in, but they are one of the lesser-known, and not-as-heavily-marketed, products in the Medicare world.

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Here’s everything you’d need to know about C-SNPs, so you can make an informed decision on whether or not you’d like to start offering them.

What Are C-SNPs?

C-SNPs are a type of MA Special Needs Plan meant for individuals with certain persistent disabling conditions. They can provide coverage for people with a select chronic condition or for people who may suffer from one (or more) of many chronic conditions.

At a minimum, C-SNPs must offer the same Medicare benefits that all MA plans must offer. More than just regular MA plans, C-SNPs aim to help their members manage their chronic conditions, avoid hospitalizations, and improve their health outlook. Oftentimes, they customize their benefits, networks, and drug formularies to better meet the needs of their members. For example, a C-SNP for people with cardiovascular disorders may have a network that includes providers who specialize in treating these disorders, and a formulary that includes special drugs used to treat these disorders. Unlike standard MA plans, Special Needs Plans, like C-SNPs, must include prescription drug coverage.

More than just regular MA plans, C-SNPs aim to help their members manage their chronic conditions, avoid hospitalizations, and improve their health outlook.

Who Qualifies for C-SNPs

Someone may qualify for a C-SNP if they have Medicare Parts A and B and the chronic condition(s) specified by the plan. The applicant must be able to prove they have the chronic condition(s). (A doctor’s note will usually suffice.) They must also live in the service area of a C-SNP, of course.

According to Medicare.gov, the chronic conditions that may qualify someone for a C-SNP include the ones listed below. CMS.gov lists additional conditions that may qualify someone for a C-SNP, if you have a client who you think could be eligible for a plan.

• Autoimmune disorders
• Cancer (excluding pre-cancer conditions)
• Cardiovascular disorders
• Chronic alcohol and other dependence
• Chronic and disabling mental health conditions
• Chronic heart failure
• Chronic lung disorders
• Dementia
• Diabetes mellitus
• End-stage liver disease
• End-stage renal disease (ESRD) requiring dialysis (any mode of dialysis)
• HIV/AIDS
• Neurologic disorders
• Severe hematologic disorders
• Stroke

From our experience, the most common types of C-SNP plans offered are for diabetes, heart disorders, and chronic lung disorder (COPD). Kidney care/ESRD plans are starting to become more prevalent, especially in larger metropolitan areas.

When Can You Sell C-SNPs?

Like with other MA plans, you can sell C-SNPs during the Annual Enrollment Period. You can also sell them to people who are in their initial enrollment period, are turning 65, or newly qualify for a C-SNP. Individuals who newly qualify for a C-SNP get a unique special enrollment period to join this type of plan. In general, agents who offer C-SNPs can sell them year-round!

Where Can You Find C-SNP Prospects?

Generally speaking, we recommend having a few C-SNP carriers in your portfolio, so you’re ready to help clients with chronic conditions that may qualify them for this type of plan. You don’t want to search for C-SNP clients in ways that could be considered “cherry picking” (e.g., at health screenings, at health fairs, genetic testing results, etc.).

Here are a few compliant ideas for prospecting for C-SNP clients:

• Consider the regular prospects that you encounter. CMS rules allow an agent to ask their client/the applicant if they have one of the chronic conditions corresponding to available C-SNPs in their market.
  • When speaking with a prospect in an area where C-SNPs are offered, an agent may say “This carrier (insert name) offers a plan that is specifically designed for people with diabetes. Would you like to learn more about this plan?”
  • If the client’s/applicant’s answer is yes, a presentation on the C-SNP plan may be appropriate.
• Make affinity/business partnerships. Develop relationships with providers who see prospects with qualifying chronic conditions. Compliant provider-based marketing can be a key to success in this market.
• Turn to your existing C-SNP clients! Don’t forget to ask for referrals from your existing C-SNP clients. These beneficiaries may know others with similar conditions.

Tip: If you’re contracted with a carrier that offers agent-sold C-SNP products in your market, reach out to your local sales manager to discuss potential compliant marketing opportunities! Many carriers also offer CMS-approved materials.

Why Sell C-SNPs?

If you can’t specifically target C-SNP clients, why should you sell them? Simply put, nowadays, the chronic conditions that qualify clients for a C-SNP are pretty prevalent across the U.S.

• According to the Centers for Disease Control and Prevention, more than 100 million American adults are living with diabetes or prediabetes. The American Diabetes Association reports that about 25 percent (12 million) of U.S. seniors, age 65 and older, have diagnosed or undiagnosed diabetes.
• The American College of Cardiology reports cardiovascular disease is the most frequent condition in older adults, as well as the leading cause of death.
• The American Heart Association reports that, every year, about 795,000 individuals have a stroke.
• The CDC states that around 15.7 million Americans report having COPD. This number could be higher, though, because over 50 percent of adults with low pulmonary function who were surveyed didn’t know they COPD, according to the CDC. People aged 65 and older were among those more likely to say they had COPD when surveyed in 2013.

You will likely meet many clients with one or more of these chronic conditions. They can receive more focused care in a C-SNP than other types of MA or Medicare plans, so it’s important to offer them access to these types of plans.

How Are They Different from the $0-premium HMO MAPD Plans?

Many C-SNP carriers offer plan benefits designed exclusively for beneficiaries with the qualifying conditions. For example, a diabetes C-SNP may offer a customized prescription benefit for some diabetic medications. The plan may also offer $0 copays for certain specialists to treat their condition. Also, C-SNP plans put a large emphasis on enhanced care coordination, and generally provide members with access to a care manager/clinical advisors and special programs to help them manage their condition.

It’s alright if C-SNPs might not have been on your radar until now. You don’t have to sell every single type of plan and attempt to accommodate every single person. However, a lot of people you’re working with now, or in the future, may qualify for these types of plans. That’s a lot of potential business on the line, and a lot of clients that you could help gain affordable access to the care they need the most.