Medicare offers Special Needs Plans (SNPs) to people with certain conditions or medical needs. Chronic Condition Special Needs Plans (C-SNPs) are plans for individuals with specific chronic conditions.
SNPs provide coverage for people with Medicaid, certain medical conditions, or specific medical needs. These plans include tailored benefits, coordination services, and formularies (lists of covered drugs) that help meet the needs of the groups they serve.
C-SNPs are health insurance plans for individuals with specific disabling or severe chronic conditions.
C-SNPs were added as Medicare plans after a panel of clinical advisors met in 2008. They recommended conditions that met the definition of severe and disabling chronic conditions.
In January 2022, the definition of severe and disabling conditions was updated.
Currently, the requirement for a C-SNP is a severe chronic condition that is disabling or life threatening. The individual with the condition must have a high risk of hospitalization or other significant adverse health outcomes. They may also require specialized care.
Read more about Medicare SNPs.
Along with the panel of clinical advisors who met in 2008, the Centers for Medicare and Medicaid Services (CMS) approved 15 chronic conditions that met the requirements to be eligible for a C-SNP.
These 15 conditions are as follows:
- chronic alcohol or other drug dependence
- autoimmune disorders that are limited to:
- cancer, which excludes in-situ status and pre-cancer conditions
- cardiovascular conditions that are limited to:
- coronary artery disease
- peripheral vascular disease
- cardiac arrhythmias
- chronic venous thromboembolic disorder
- dementia
- chronic heart failure
- end stage liver disease
- diabetes mellitus
- end stage renal disease (ESRD) that requires dialysis
- severe hematologic disorders that are limited to:
- sickle cell disease (not including sickle cell trait)
- hemophilia
- aplastic anemia
- immune thrombocytopenic purpura
- myelodysplastic syndrome
- HIV and AIDS (stage 3 HIV)
- chronic lung conditions that are limited to:
- disabling and chronic mental health conditions that are limited to:
- stroke
- neurologic disorders that are limited to:
When completing an application for a C-SNP, a Medicare Advantage Organization (MAO) may do so in a way that targets one of the following:
- a single chronic condition approved by the CMS
- a group of multiple conditions approved by the CMS
- a group of multiple conditions customized by the MAO
The CMS has approved groups of comorbid (commonly co-occurring) and clinically linked conditions for C-SNPs.
These five groups are as follows:
- chronic heart failure and diabetes mellitus
- cardiovascular disorders and chronic heart failure
- cardiovascular disorders and diabetes mellitus
- chronic heart failure, diabetes mellitus, and cardiovascular disorders
- cardiovascular disorders and stroke
An SNP provides coverage and benefits for people with:
- certain healthcare needs
- specific conditions
- Medicaid
A person can join an SNP if they meet all of the eligibility requirements. These requirements are that the person:
- have both Medicare Part A and Part B
- live within the plan’s service area
- meet the eligibility requirements for one of the three types of SNPs:
- chronic condition (C-SNP)
- dual eligible (D-SNP)
- institutional (I-SNP)
D-SNPs are plans for people who are eligible for both Medicare and Medicaid.
I-SNPs are plans for people who live in the community but require the care that a facility offers. I-SNPs can also be offered to people who have lived in or expect to live in a facility for at least 90 days. Examples of these facilities include psychiatric hospitals, skilled nursing facilities nursing homes, and rehabilitation hospitals.
Read about Medicare and Medicaid.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
C-SNPs are Medicare plans for individuals with specific chronic conditions. The CMS has approved 15 conditions that qualify for this type of plan. It has also grouped some of the conditions together to help with eligibility requirements.
If a person has any questions about Medicare plans or eligibility, they can contact Medicare at 800-633-4227 or chat with someone online.