Medicare Chronic Special Needs Plan (C-SNP)
What are Special Needs Plans?
Special Needs Plans (SNPs) were created by Congress as part of the Medicare Modernization Act (MMA) of 2003 to provide care to individuals with special needs with specific severe or disabling chronic conditions. There are three types of SNPs:
Dual
For people on both Medicare and a state Medicaid program.
Chronic
For people with disabling or continuous health conditions.
Institutional
For people who need the type of high-level long-term care provided by an institutional facility.
Dual
For people on both Medicare and a state Medicaid program.
Chronic
For people with disabling or continuous health conditions.
Institutional
For people who need the type of high-level
long-term care provided by an institutional facility.
What are Chronic Special Needs Plans?
A Chronic Special Needs (C-SNP) plan is a type of Medicare Advantage (MA) plan designed to meet the unique needs of people with one or more chronic or disabling conditions. Of all SNP plans, C-SNPS make up 15% of enrollees per 2025 data. 1
C-SNPs are offered by private insurance companies for certain qualified individuals. In addition to all the benefits of Original Medicare Part A and Part B, C-SNPs are required to provide prescription drug coverage and most include coverage for routine dental, vision, and hearing care in addition to special benefits specific to the condition being treated.
Who is Eligible for a Chronic Special Needs Plan?
To enroll in a C-SNP, you must have Medicare Part A and Part B and your doctor must verify that you have a qualifying health condition. Common qualifying conditions include diabetes, chronic heart failure, and chronic lung disease.
You may be eligible for a C-SNP if you have one or more of the following conditions, depending on the carrier and the plans available in your area:
- Chronic alcohol and other dependence
- Certain autoimmune disorders
- Cancer (excluding pre-cancer conditions)
- Certain cardiovascular disorders
- Chronic heart failure
- Dementia
- Diabetes mellitus
- End-stage liver disease
- End-Stage Renal Disease (ESRD) requiring dialysis
- (any mode of dialysis) Certain severe hematologic disorders
- HIV/AIDS
- Certain chronic lung disorders
- Certain chronic and disabling mental health conditions
- Certain neurologic disorders
- Stroke
What Does Medicare Part B do for Chronic Conditions?
Medicare Part B has benefits for people with chronic conditions. These include access to hospitals and medical professionals who specialize in the condition or disease. C-SNPs also use drug formularies geared toward the needs of their members. Other benefits may include health and wellness programs, nutrition or substance abuse counseling, or diabetes management services.
Medicare & Diabetes Mellitus
Diabetics on Medicare can benefit from blood glucose monitoring, insulin management, nutritional training and foot care. An endocrinologist (diabetes specialist) can help individuals with a coordinated care plan.
Medicare & End-Stage Renal Disease (ESRD)
Those with kidney disease can receive personal support, nutritional training, and other necessary treatments under their Part B coverage.
Medicare & Chronic lung disorders
Those with lung-related disorders may get access to items like oxygen supplies and other medical equipment in addition to pulmonologist (lung specialist) care and coordination.
Medicare Chronic Care Management Services
Chronic care management services are a specific Medicare Part B benefit for people with two or more chronic conditions.
Talk to An Agent to Learn More About Plan Benefits
C-SNP vs. Standard Medicare Advantage
All Medicare Advantage plans must provide all the benefits of Medicare Parts A (hospital coverage) and B (medical coverage). C-SNPs are also required to have prescription drug (Part D) coverage. In addition, C-SNPs may also include the following. Please see your specific insurance carrier for more information on what is offered.
Dental, Vision, & Hearing:
Also offered in many Medicare Advantage plans, C-SNP members are provided additional coverage as part of their supplemental benefits. This may include lower to no co-pays.
Care Management:
C-SNP members may receive care management through a care manager. A care manager performs disease, behavioral, social, and functional specific assessments when deficits or needs are identified. Additionally, the Care Managers review claims and pharmacy data and may help with coordinating doctor visits or other needs.
Post-Discharge:
Members may receive a care transition assessment upon discharge, which includes a coordination of services tailored to the member’s individualized care needs.
Transportation
While a standard Medicare Advantage plan may include some transportation for medically related trips, a C-SNP may offer more of this benefit. In general, medically related trips can be used as needed throughout the year with no limit on mileage in the service area.
Home-Delivered Meals:
Another benefit also found in standard Medicare Advantage plans that may be offered more in a C-SNP. This benefit immediately follows an inpatient hospital stay.
In-Home Visits:
Some C-SNPs may offer in-home visits from a care practitioner to address the members’ individual health care needs and chronic conditions.
Telemedicine/ Telehealth:
Medicare Advantage plans are required to offer telehealth services because of COVID-19. C-SNPs may expand this coverage.
In-Home Monitoring:
C-SNP may include in-home monitoring specific to the condition. Some examples follow:
- Hypertension: A blood pressure device for those with hypertension.
- Diabetes: A glucose monitor with replacement strips for those with diabetes.
- Chronic Obstructive Pulmonary Disease (COPD): An oximeter provides cellular-connected
measurement of oxygen saturation in the bloodstream for those with COPD. - Congestive Heart Failure: A scale may be used for cellular connected weight management.
Medication Management:
This benefit may include periodic reviews of medications by a pharmacist with the enrollee.
Dental, Vision, & Hearing:
Also offered in many Medicare Advantage plans, C-SNP members are provided additional coverage as part of their supplemental benefits. This may include lower to no co-pays.
Care Management:
C-SNP members may receive care management through a care manager. A care manager performs disease, behavioral, social, and functional specific assessments when deficits or needs are identified. Additionally, the Care Managers review claims and pharmacy data and may help with coordinating doctor visits or other needs.
Post-Discharge:
Members may receive a care transition assessment upon discharge, which includes a coordination of services tailored to the member’s individualized care needs.
Transportation
While a standard Medicare Advantage plan may include some transportation for medically related trips, a C-SNP may offer more of this benefit. In general, medically related trips can be used as needed throughout the year with no limit on mileage in the service area.
Home-Delivered Meals:
Another benefit also found in standard Medicare Advantage plans that may be offered more in a C-SNP. This benefit immediately follows an inpatient hospital stay.
In-Home Visits:
Some C-SNPs may offer in-home visits from a care practitioner to address the members’ individual health care needs and chronic conditions.
Telemedicine/ Telehealth:
Medicare Advantage plans are required to offer telehealth services because of COVID-19. C-SNPs may expand this coverage.
In-Home Monitoring:
C-SNP may include in-home monitoring specific to the condition. Some examples follow:
Hypertension:
A blood pressure device for
those with hypertension.
Diabetes:
A glucose monitor with replacement
strips for those with diabetes.
Chronic Obstructive Pulmonary Disease (COPD):
An oximeter provides cellular- connected measurement of oxygen saturation in the bloodstream for those with COPD.
Congestive Heart Failure:
A scale may be used
for cellular connected weight management.
Medication Management:
This benefit may include periodic reviews of medications by a pharmacist with the enrollee.
How do I Enroll in a C-SNP?
You must have Medicare Part A and Part B, and your doctor must verify that you have a qualifying health condition.
To disenroll or enroll in a Medicare Advantage plan, you must be in an enrollment period.
If you are not currently a C-SNP enrollee, you are eligible for a special enrollment period (SEP) to change to or add C-SNP coverage. You are also eligible for a SEP for every additional chronic illness that is not covered by any current C-SNP.
In addition, you can enroll in a C-SNP during any Medicare Advantage enrollment period.
Contact Clear Spring Health to discuss eligibility and shop C-SNPs in your area today!
Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage Plan that focuses on certain vulnerable groups of Medicare beneficiaries. SNPs are required to submit a Model of Care (MOC) to the Centers for Medicare & Medicaid Services (CMS) for review and approval by the National Committee for Quality Assurance (NCQA). Clear Spring Healthcare has received 3-year approvals for our Chronic SNP (C-SNP) for the following contracts (H6672, H5454, H6379), which is the maximum approval period. The C-SNP Model of Care has been approved for the following chronic conditions: cardiovascular, diabetes and congestive heart failure.
If you have questions regarding our approval by NCQA, please contact our Quality Improvement Team at 1 844-895-9047. Monday – Friday, 8 am – 5 pm EST. Messaging service used weekends, after hours, and Federal holidays.
1 https://www.medicaremarketinsights.com/p/aep-2025-part-ma-mapd-enrollment-growth-by-plan
Y0145_MK X044_091724_C
Medicare Chronic Special Needs Plan (C-SNP)
What are Special Needs Plans?
Special Needs Plans (SNPs) were created by Congress as part of the Medicare Modernization Act (MMA) of 2003 to provide care to individuals with special needs with specific severe or disabling chronic conditions. There are three types of SNPs:
Dual
For people on both Medicare and a state Medicaid program.
Chronic
For people with disabling or continuous health conditions.
Institutional
For people who need the type of high-level long-term care provided by an institutional facility.
Dual
For people on both Medicare and a state Medicaid program.
Chronic
For people with disabling or continuous health conditions.
Institutional
For people who need the type of high-level
long-term care provided by an institutional facility.
What are Chronic Special Needs Plans?
A Chronic Special Needs (C-SNP) plan is a type of Medicare Advantage (MA) plan designed to meet the unique needs of people with one or more chronic or disabling conditions. Of all SNP plans, C-SNPS make up 15% of enrollees per 2025 data. 1
C-SNPs are offered by private insurance companies for certain qualified individuals. In addition to all the benefits of Original Medicare Part A and Part B, C-SNPs are required to provide prescription drug coverage and most include coverage for routine dental, vision, and hearing care in addition to special benefits specific to the condition being treated.
Who is Eligible for a Chronic Special Needs Plan?
To enroll in a C-SNP, you must have Medicare Part A and Part B and your doctor must verify that you have a qualifying health condition. Common qualifying conditions include diabetes, chronic heart failure, and chronic lung disease.
You may be eligible for a C-SNP if you have one or more of the following conditions, depending on the carrier and the plans available in your area:
- Chronic alcohol and other dependence
- Certain autoimmune disorders
- Cancer (excluding pre-cancer conditions)
- Certain cardiovascular disorders
- Chronic heart failure
- Dementia
- Diabetes mellitus
- End-stage liver disease
- End-Stage Renal Disease (ESRD) requiring dialysis
- (any mode of dialysis) Certain severe hematologic disorders
- HIV/AIDS
- Certain chronic lung disorders
- Certain chronic and disabling mental health conditions
- Certain neurologic disorders
- Stroke
What Does Medicare Part B do for Chronic Conditions?
Medicare Part B has benefits for people with chronic conditions. These include access to hospitals and medical professionals who specialize in the condition or disease. C-SNPs also use drug formularies geared toward the needs of their members. Other benefits may include health and wellness programs, nutrition or substance abuse counseling, or diabetes management services.
Medicare & Diabetes Mellitus
Diabetics on Medicare can benefit from blood glucose monitoring, insulin management, nutritional training and foot care. An endocrinologist (diabetes specialist) can help individuals with a coordinated care plan.
Medicare & End-Stage Renal Disease (ESRD)
Those with kidney disease can receive personal support, nutritional training, and other necessary treatments under their Part B coverage.
Medicare & Chronic lung disorders
There is no network of providers. Any Medicare provider who agrees to the plan’s terms and payments can be seen. Providers can decide on a case-by-case and visit-by-visit basis whether to see a Medicare beneficiary.
Medicare Chronic Care Management Services
Chronic care management services are a specific Medicare Part B benefit for people with two or more chronic conditions.
Talk to An Agent to Learn More About Plan Benefits
C-SNP vs. Standard Medicare Advantage
All Medicare Advantage plans must provide all the benefits of Medicare Parts A (hospital coverage) and B (medical coverage). C-SNPs are also required to have prescription drug (Part D) coverage. In addition, C-SNPs may also include the following. Please see your specific insurance carrier for more information on what is offered.
Dental, Vision, & Hearing:
Also offered in many Medicare Advantage plans, C-SNP members are provided additional coverage as part of their supplemental benefits. This may include lower to no co-pays.
Care Management:
C-SNP members may receive care management through a care manager. A care manager performs disease, behavioral, social, and functional specific assessments when deficits or needs are identified. Additionally, the Care Managers review claims and pharmacy data and may help with coordinating doctor visits or other needs.
Post-Discharge:
Members may receive a care transition assessment upon discharge, which includes a coordination of services tailored to the member’s individualized care needs.
Transportation
While a standard Medicare Advantage plan may include some transportation for medically related trips, a C-SNP may offer more of this benefit. In general, medically related trips can be used as needed throughout the year with no limit on mileage in the service area.
Home-Delivered Meals:
Another benefit also found in standard Medicare Advantage plans that may be offered more in a C-SNP. This benefit immediately follows an inpatient hospital stay.
In-Home Visits:
Some C-SNPs may offer in-home visits from a care practitioner to address the members’ individual health care needs and chronic conditions.
Telemedicine/ Telehealth:
Medicare Advantage plans are required to offer telehealth services because of COVID-19. C-SNPs may expand this coverage.
In-Home Monitoring:
C-SNP may include in-home monitoring specific to the condition. Some examples follow:
- Hypertension: A blood pressure device for those with hypertension.
- Diabetes: A glucose monitor with replacement strips for those with diabetes.
- Chronic Obstructive Pulmonary Disease (COPD): An oximeter provides cellular-connected
measurement of oxygen saturation in the bloodstream for those with COPD. - Congestive Heart Failure: A scale may be used for cellular connected weight management.
Medication Management:
This benefit may include periodic reviews of medications by a pharmacist with the enrollee.
Dental, Vision, & Hearing:
Also offered in many Medicare Advantage plans, C-SNP members are provided additional coverage as part of their supplemental benefits. This may include lower to no co-pays.
Care Management:
C-SNP members may receive care management through a care manager. A care manager performs disease, behavioral, social, and functional specific assessments when deficits or needs are identified. Additionally, the Care Managers review claims and pharmacy data and may help with coordinating doctor visits or other needs.
Post-Discharge:
Members may receive a care transition assessment upon discharge, which includes a coordination of services tailored to the member’s individualized care needs.
Transportation
While a standard Medicare Advantage plan may include some transportation for medically related trips, a C-SNP may offer more of this benefit. In general, medically related trips can be used as needed throughout the year with no limit on mileage in the service area.
Home-Delivered Meals:
Another benefit also found in standard Medicare Advantage plans that may be offered more in a C-SNP. This benefit immediately follows an inpatient hospital stay.
In-Home Visits:
Some C-SNPs may offer in-home visits from a care practitioner to address the members’ individual health care needs and chronic conditions.
Telemedicine/ Telehealth:
Medicare Advantage plans are required to offer telehealth services because of COVID-19. C-SNPs may expand this coverage.
In-Home Monitoring:
C-SNP may include in-home monitoring specific to the condition. Some examples follow:
Hypertension:
A blood pressure device for
those with hypertension.
Diabetes:
A glucose monitor with replacement
strips for those with diabetes.
Chronic Obstructive Pulmonary Disease (COPD):
An oximeter provides cellular- connected measurement of oxygen saturation in the bloodstream for those with COPD.
Congestive Heart Failure:
A scale may be used
for cellular connected weight management.
Medication Management:
This benefit may include periodic reviews of medications by a pharmacist with the enrollee.
How do I Enroll in a C-SNP?
You must have Medicare Part A and Part B, and your doctor must verify that you have a qualifying health condition.
To disenroll or enroll in a Medicare Advantage plan, you must be in an enrollment period.
If you are not currently a C-SNP enrollee, you are eligible for a special enrollment period (SEP) to change to or add C-SNP coverage. You are also eligible for a SEP for every additional chronic illness that is not covered by any current C-SNP.
In addition, you can enroll in a C-SNP during any Medicare Advantage enrollment period.
Contact Clear Spring Health to discuss eligibility and shop C-SNPs in your area today!
Medicare Special Needs Plans (SNPs) are a type of Medicare Advantage Plan that focuses on certain vulnerable groups of Medicare beneficiaries. SNPs are required to submit a Model of Care (MOC) to the Centers for Medicare & Medicaid Services (CMS) for review and approval by the National Committee for Quality Assurance (NCQA). Clear Spring Healthcare has received 3-year approvals for our Chronic SNP (C-SNP) for the following contracts (H6672, H5454, H6379), which is the maximum approval period. The C-SNP Model of Care has been approved for the following chronic conditions: cardiovascular, diabetes and congestive heart failure.
If you have questions regarding our approval by NCQA, please contact our Quality Improvement Team at 1 844-895-9047. Monday – Friday, 8 am – 5 pm EST. Messaging service used weekends, after hours, and Federal holidays.
1 https://www.medicaremarketinsights.com/p/aep-2025-part-ma-mapd-enrollment-growth-by-plan
Y0145_MK X044_091724_C
Clear Spring Health agents can help you find a plan.
Shop and compare plans with an agent
Clear Spring Health agents can help you find a plan.
Shop and compare plans with an agent