1. Who is eligible to enroll in a Chronic Special Needs Plan (C-SNP)?
Medicare beneficiaries who have one or more medically complex chronic conditions that are: disabling or life-threatening, have a high risk of hospitalization or other adverse health outcomes, and require specialized care delivery systems.
These individuals must meet the plan’s specific criteria based on CMS approved chronic conditions.
Beneficiaries must also be enrolled in Medicare Parts A and B and live in the plan’s service area.
A. How does a person under 65 get Medicare and CSNP?
They can do so by applying for Social Security Disability.
After qualifying for SS- the individual may be eligible for Medicare A & B. (With no premium)
After getting Medicare A & B- The beneficiary can be eligible for a CSNP if they have a specific chronic condition.
2. What are the specific chronic conditions that qualify someone for a C-SNP?
CMS has approved 15 specific chronic condition categories for C-SNP eligibility:
• Chronic alcohol and other drug dependence
• Autoimmune disorders
• Cancer
• Cardiovascular disorders
• Chronic heart failure
• Dementia
• Diabetes
• End-stage liver disease
• End-stage renal disease requiring dialysis
• Severe hematologic disorders (example -anemia, sickle-cell disease)
• HIV/AIDS
• Chronic lung disorders
• Chronic and disabling mental health conditions
• Neurologic disorders
• Stroke
*Not all of these conditions will be available in every members area.*
3. How does a plan verify a client’s eligibility for a CSNP?
The plan requires the beneficiaries existing provider to verify the qualifying chronic condition within 60 days of the effective date. Plans may use a CMS approved pre-enrollment assessment tool and a chronic condition release information form.
The plan will contact the members’ primary care provider to confirm diagnosis.
4. When can I help a client enroll in a C-SNP?
Beneficiaries can enroll in a C-SNP during the Annual Enrollment Period (October 15–December 7), the Medicare Advantage Open Enrollment Period (January 1–March 31), or the beneficiaries Initial Enrollment Period.
They can join at any time using a Special Enrollment Period if they have a qualifying severe or disabling chronic condition and a C-SNP is available in their area.
5. What Special Enrollment Periods (SEPs) apply specifically to C-SNPs?
A SEP is available for individuals with a severe or disabling chronic condition. If a beneficiary develops a qualifying condition after initial enrollment, they may use this SEP to enroll.
6. How should I market C-SNPs to potential clients?
Mostly it’s more organic. You must market C-SNPs to all eligible individuals in the service area, using Medicare Advantage marketing rules. Marketing materials targeting potential enrollees must include a disclaimer stating that enrollment is limited to individuals meeting the plan’s special needs criteria.
7. What happens if a client in a C-SNP no longer meets the eligibility criteria?
If a beneficiary loses their special needs status, the plan must send a notice of disenrollment. The beneficiary can qualify for a SEP starting the month they lose status, allowing them to join another Medicare Advantage.
8. Can I switch a client from a Dual Eligible Special Needs Plan (D-SNP) to a C-SNP?
Yes, if the client meets the C-SNP’s chronic condition eligibility and a CSNP is available in the beneficiaries coverage areas. Any changes will be effective the first of the next month. Changes can also occur during AEP or OEP.
9. What role do I play in the enrollment process for a C-SNP?
You can assist clients in completing the enrollment request, which must include verifying the CSNP’s eligibility. Agents can enroll Medicare beneficiaries into CSNPs and get a commission on the policy.
10. When should I recommend switching a client from a D-SNP to a C-SNP?
Only if the client has a qualifying chronic condition and the C-SNP offers better benefits for their specific needs, such as specialized care for conditions like diabetes or heart failure.
A. Can Dual eligibles switch using their monthly SEP if they prefer the C-SNP’s over D-SNP?
NO! – Only for DSNPs -Monthly SEPs allows beneficiaries to disenroll from MA DSNPs and Switch to Original Medicare and a stand-alone Part D drug plan.
OR…
Full Benefit Dual Eligibles can switch between certain integrated DSNPs that align Medicare and Medicaid benefits.
11. What disclaimers must I include when selling C-SNPs?
All marketing materials must include a disclaimer that “This is a CSNP. Enrollment is limited to Medicare beneficiaries with specific severe or disabling chronic conditions.”
12. How are C-SNPs structured to benefit clients with multiple chronic conditions?
C-SNPs can be structured around a single condition, combinations from the 15 conditions, but can’t combine unrelated conditions to create a general product. They provide tailored benefits, specialized networks, and cost-sharing focused on the conditions.
13. What additional benefits do CSNPs offer that I can highlight to clients?
C-SNPs must provide Part D prescription drug coverage and offer benefits beyond Original Medicare, such as lower cost-sharing, specialized provider networks, preventive services, wellness programs, and care coordination tailored to the chronic condition.
14. What is the biggest issue when switching a Medicare Beneficiary from DSNP to CSNP?
Lack of Integration between Medicare and Medicaid. DSNPs are designed for individuals with both Medicare and Medicaid. CSNPs are designed for individuals with specific chronic conditions. If a beneficiary is switched from a DSNP to a CSNP, they may lose benefits from Medicaid.
They could lose the coordination of care and experience gaps in care. Also, they could face higher out-of-pocket costs.
15. I received an email from a carrier saying I have a Mis-Aligned enrollment. What does that mean?
It means that the plan you switched the member into is not aligned or does not coordinate with Medicaid.
(It could and probably will cause issues with the members extra benefits. The CSNP does not have those benefits, so the member will lose those programs.)