There are special types of Medicare Advantage Plans that are designed for those with specific needs or if they meet certain criteria. These plans are called Special Needs Plans or SNP’s. One of those kinds of SNP’s is called a Chronic Care Special Needs Plan or a C-SNP.
SNPs cover all of the same core Medicare benefits that other Medicare Advantage plans must cover and have additional benefits tailored to the special groups they serve, in this case, those with specific chronic conditions. Each plan offered by different insurance companies can have different benefits, so to see exactly what additional benefits are provided, you will need to review the specific C-SNP plans sold by each insurance company in your area.
C-SNPs are SNPs that restrict enrollment to those with specific severe or disabling chronic conditions. According to Medicare, approximately two-thirds of Medicare enrollees have multiple chronic conditions. These multiple conditions require a coordinated approach from primary care doctors, medical and mental health specialists, inpatient and outpatient facilities, ancillary services related to diagnostic testing, and more to ensure they can obtain the best possible healthcare given their conditions.
Every SNP plan has something called a Model of Care (MOC). The Model of Care outlines the specific goals and objectives for the SNP population, including conducting Health Risk Assessments and working with an Interdisciplinary Care Team tasked with coordinating the delivery of services and benefits to the C-SNP members. The team consults with the member to develop a comprehensive individualized care plan that addresses their specific needs.
The following are the types or categories of C-SNPs that are available. However, not all (or even any) may be available in your area.
• Chronic alcohol and other drug dependence
• Autoimmune disorders
• Cancer, excluding pre-cancer conditions or in-situ status
• Cardiovascular
• Chronic heart failure
• Dementia
• Diabetes mellitus
• End-stage liver disease
• End-stage renal disease (ESRD) requiring dialysis
• Severe hematologic disorders
• HIV/AIDS
• Chronic lung disorders
• Chronic and disabling mental health conditions
• Neurologic disorders
• Stroke
In addition to C-SNPs for individual conditions, there are also some that deal with groups of commonly co-morbid and clinically-linked conditions.
Some Medicare SNPs use a care coordinator to help their C-SNP members stay healthy and compliant with their doctor’s orders and taking their prescriptions. For example, some of the things a care coordinator for a C-SNP for diabetes might help members do some of the following:
• Monitor their blood sugar
• Follow their diet
• Get proper exercise
• Schedule preventive services (like eye and foot exams)
• Get the right prescriptions to prevent complications
If you are enrolled in a C-SNP, you can stay enrolled as long as you continue to meet the special conditions served by the plan. If you no longer have the conditions identified to be enrolled in the plan, you have a grace period of at least one month in which you can stay enrolled in the C-SNP. However, some insurance companies have a longer grace period. If you lose eligibility for the plan, you will be given a Special Enrollment Period to enroll in another plan. This Special Enrollment Period starts when your Medicare C-SNP notifies you that you are no longer eligible continues through the grace period and for two months after your coverage ends. During this time, you should enroll in another plan, so you don’t lose coverage. If you find yourself in this situation, an experienced independent agent like Maura O’Toole from the FitzGibbons Agency, who can be reached at 315-312-0803, can help you find and enroll in a new plan.
Have further Questions? Just Ask Fitz!
Maura O’Toole
FitzGibbons Agency
44 E Bridge St, Suite 1
Oswego, NY 13126
(315) 312-0803
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