2/3 of Medicare enrollees have 2+ chronic conditions. Humana's C-SNP plan can help manage them.

Two in three Medicare enrollees have multiple chronic conditions. Managing those conditions requires extensive coordination between the patient’s primary care physician, specialists, and pharmacists – not to mention additional support to help navigate daily life.

In response to this need, CMS permits Medicare Advantage organizations like Humana,  to create Chronic Condition Special Needs Plans or C-SNPS. Here’s what health insurance agents need to know about this growing market.

Who is eligible for C-SNPs?

C-SNP enrollment is restricted to those with specific severe or disabling chronic conditions. C-SNPs can be built to serve enrollees with a single CMS-approved chronic condition, a CMS-approved group of chronic conditions, or a combination of chronic conditions specified by the plan.

There are 15 SNP-specific chronic conditions, including things like substance dependence, diabetes, and end-stage renal disease. There are also CMS-approved condition groupings, which pair things like diabetes and heart failure, or stroke and cardiovascular disorders. Check out the chart below for a brief list of these conditions. A full list is provided by CMS.

And, just like with other Medicare Advantage plans, beneficiaries must be enrolled in Medicare Parts A and B, and reside in the plan’s service area.

What sets C-SNPS apart?

• More flexible enrollment opportunities: Of course, your clients can enroll at all the usual times: during their Initial Enrollment Period, when they turn 65, or when they newly qualify for a C-SNP. You read that right – as soon as someone is diagnosed with qualifying conditions, they may qualify for a Special Enrollment Period, assuming a plan is available in their area. Since new diagnoses occur every day, having a C-SNP in your portfolio will help clients needing this support. But, be careful to avoid anything that could look like “cherry-picking” at health screenings or health fairs –either for these or any other Medicare products.
• Support from care coordinators: One condition of offering any SNP is that beneficiaries must be paired with a care coordinator from the carrier. That coordinator works with your client, their physicians, and mental health professionals, as well as other resources to develop an effective treatment plan. 
• Benefits built to target the condition:  C-SNPs often build their benefits to be used. For example, a C-SNP targeting chronic lung conditions may reduce the specialist copay for pulmonologists to $0. C-SNPs for heart failure may create a special formulary tier for related drugs, offering them at a steep discount to what the member might see on the same carriers’ other MAPD plans. Other plans might lean hard into value-added benefits, and provide access to additional management programs and support groups

How do I get started?

Beginning in coverage year 2024, Humana now offers a C-SNP in select Michigan counties. And, this is only one of a few C-SNPs available in the entire state. If you’re looking for a solution that helps support your clients with diabetes, heart failure, and/or heart disease, we can help you get appointed with our newest carrier partner.