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

What is a Special Needs Plan?

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

Search, Compare  & Try to find plans? 

Medicare.Gov

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 *

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Links & Resources

Blue Cross Explanation  

Nolo.Com

CA Health Advocates.org

The State Health Insurance Assistance Programs (SHIPs) provide free, in depth, one-on-one insurance counseling and assistance to Medicare beneficiaries, their families, friends, and caregivers.

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  

Email us

Medicare Special Needs Plans

Special Needs Plans #11302
Special Needs Plans * #11302 Outdated 11.2011  *

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 2019 - Everything you want to knowMedicare and You 2019 #10050 - Everything you want to know * See their section on closing the donut hole

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