C-SNP Eligibility and Enrollment

Individuals who qualify for Medicaid are not the only ones who qualify for a Special Needs Plan.

In addition to the Dual Eligible Special Needs Plan, there is also the Chronic Condition Special Needs Plan or C-SNP.

To be eligible for a C-SNP, the client must have Parts A & B, live in the plan’s service area, and must have one or more qualifying chronic conditions specified in the plan.

The Centers for Medicare and Medicaid Service, or CMS, has laid out 15 chronic conditions that can be covered by C-SNPs.

This list includes conditions like diabetes, stroke, and select chronic lung disorders, to name a few.

C-SNPs limit their eligibility to individuals with one condition or those with multiple conditions.

In the case that the C-SNP accepts multiple conditions, the individual only needs to have one of the qualifying conditions for enrollment.

In order to verify which conditions are covered, you’ll want to review the summary of benefits for the C-SNPs in your market.

Understanding what C-SNPs cover in your market will help you ask more specific questions to verify eligibility and uncover other possibilities for your clients!

Now that you’ve identified that your client has a qualifying Chronic Condition for a C-SNP in their service area, when can they join a plan?

Well, they have the same opportunities they’d have for standard Medicare Advantage enrollments like AEP and SEPs.

Like the D-SNPs, these also have a specific Special Enrollment Period that can be used if they qualify for a C-SNP.

This SEP would be available while the individual has the qualifying condition and would end once the individual enrolls in a C-SNP using it.

Once this SEP is used, a beneficiary will need to use other applicable Medicare election periods to make changes to their plan.

Being aware of this SEP can help you serve your clients by offering them some tailored coverage for their condition.

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