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.
Severe hematologic disorders
Certain mental health conditions
Chronic heart failure
End-stage liver disease
Some neurologic disorders
ESRD requiring dialysis
Chronic lung disorders
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.