What is a Medicare MAPD Special Needs Chronic Condition SNP – C-SNP Plan?

Medicare SNPs  Special Needs Plans are a type of Medicare Advantage Plan (like an HMO or PPO). Medicare SNPs limit membership to people with specific diseases or characteristics. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve. Medicare.gov

A special needs plan (SNP) is a Medicare Advantage (MA) coordinated care plan (CCP) specifically designed to provide targeted care and limit enrollment to special needs individuals.  A special needs individual could be any one of the following:

  1. An institutionalized individual,
  2. A dual eligible, or
  3. An individual with a severe or disabling chronic condition, as specified by CMS.

A SNP may be any type of MA CCP, including either a local or regional preferred provider organization (i.e., LPPO or RPPO) plan, a health maintenance organization (HMO) plan, or an HMO Point-of-Service (HMO-POS) plan.  There are three different types of SNPs:

  1. Chronic Condition SNP (C-SNP)
  2. Dual Eligible SNP (D-SNP)
  3. Institutional SNP (I-SNP)  cms.govSpecialNeedsPlans  *

Can I get my health care from any doctor, other health care provider, or hospital?

You generally must get your care and services from doctors, other health care providers, or hospitals in the plan’s network (except emergency care, out-of-area urgent care, or out-of-area dialysis).

Are prescription drugs covered?

Yes. All SNPs must provide Medicare prescription drug coverage (Part D).

Do I need to choose a primary care doctor?

Generally, yes.

Do I have to get a referral to see a specialist?

In most cases, yes. Certain services, like yearly screening mammograms, don’t require a referral.

What else do I need to know about this type of plan?

A plan must limit membership to these groups:

1) people who live in certain institutions (like nursing homes) or who require nursing care at home, or

2) people who are eligible for both
Medicare and Medicaid, or

3) people who have specific chronic or disabling conditions (like diabetes, End-Stage Renal Disease, HIV/AIDS, chronic heart failure, or dementia).

Plans may further limit membership.

Plans will coordinate the services and providers you need to help you stay healthy and follow doctors’ or other health care providers’ orders.

Visit Medicare.gov/find-a-plan or check our child pages or

SNP Benefits 
 Click to enlarge

Chronic Condition Special Needs Plans  C SNP

Scan Foundation Summary on Chronic Care Act 

Forbes  * Commonwealth Fund - Social Services

home-delivered meals, transportation for nonmedical needs, pest control, indoor air quality equipment (e.g., air conditioner for someone with asthma), and minor home modifications (e.g., permanent ramps, widening of hallways or doorways to accommodate wheelchairs).    Listening

telehealth is  the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.

Telehealth is different from telemedicine because it refers to a broader scope of remote healthcare services than telemedicine. While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services.  Learn More Health IT.gov  *  Telehealth  *  Modern Health Care  *

Chronic Conditions List

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

Links & Resources

Blue Cross Explanation

Nolo.Com

CA Health Advocates.org

CA Dept of Aging – HICAP (Local SHIP) – Center for Health Care Rights – 1-800-434-0222

CMS – Medicare – List of conditions for Special Needs Plans

Medicare Managed Care Manual – SNP  Chapter 16 B 

better medicare alliance.org/IssueBrief

Wikipedia

medicare.gov/special-needs-plans-snp

Management Services 

Aetna.com Model of Care

Vantage Health Plan Annual Training 

Cal Broker Magazine

Chronic care management services

If you have 2 or more serious, chronic conditions (like arthritis, asthma, diabetes, hypertension, heart disease, osteoporosis, and other conditions) that are expected to last at least a year, Medicare may pay for a health care provider’s help to manage those conditions. This includes a comprehensive care plan that lists your health problems and goals, other health care providers, medications, community services you have and need, and other information about your health. It also explains the care you need and how your care will be coordinated. Your health care provider will ask you to sign an agreement to provide this service. If you agree, he or she will prepare the care plan, help you with medication management, provide 24/7 access for urgent care needs, give you support when you go from one health care setting to another, review your medicines and how you take them, and help you with other chronic care needs. You pay a monthly fee, and the Part B deductible and coinsurance apply.  medicare.gov/10050-Medicare-and-You  

Medicare and You 2020 #10050  
Everything you want to know 

Medicare and you

Different Parts of Medicare 

A = Hospital
B = Doctor Visits - Out Patient
C = Medicare Advantage or Medi Gap
D = Part D Rx

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How to sign up for Parts A & B
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