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Chronic Condition Special Needs Plans (C-SNPs) are a form of Medicare Advantage available to those who, according to the Center for Medicare and Medicaid Services, (CMS) “who have one or more comorbid and medically complex chronic conditions that are substantially disabling or life threatening; have a high risk of hospitalization or other significant adverse health outcomes; and require specialized delivery systems across domains of care.”

In other words, you are eligible for a C-SNP plan if you are suffering from a chronic health condition.

List of Conditions Covered by a C-SNP Plan

To understand if your condition is covered under a C-SNP, they are broken down into four general categories:

  • Group 1:  Diabetes mellitus and chronic heart failure;
  • Group 2:  Chronic heart failure and cardiovascular disorders;
  • Group 3:  Diabetes mellitus and cardiovascular disorders;
  • Group 4:  Diabetes mellitus, chronic heart failure, and cardiovascular disorders; and
  • Group 5:  Stroke and cardiovascular disorders.

These groups each include specific conditions that are eligible for a C-SNP plan. Here is an expanded list to help you better understand your eligibility:

  • Chronic alcohol and other drug dependence
  • Autoimmune disorders limited to:
  • Polyarteritis nodosa
  • Polymyalgia rheumatica
  • Polymyositis
  • Rheumatoid arthritis
  • Systemic lupus erythematosus
  • Cancer (excluding pre-cancer conditions or in-situ status)
  • Cardiovascular disorders limited to:
  • Cardiac arrhythmias
  • Coronary artery disease
  • Peripheral vascular disease
  • Chronic venous thromboembolic disorder
  • Chronic heart failure
  • Dementia
  • Diabetes mellitus
  • End-stage liver disease
  • End-stage renal disease (ESRD) requiring dialysis
  • Severe hematologic disorders limited to:
  • Aplastic anemia
  • Hemophilia
  • Immune thrombocytopenic purpura
  • Myelodysplastic syndrome
  • Sickle-cell disease (excluding sickle-cell trait)
  • Chronic lung disorders limited to:
  • Asthma
  • Chronic bronchitis
  • Emphysema
  • Pulmonary fibrosis
  • Pulmonary hypertension
  • Chronic and disabling mental health conditions limited to:
  • Bipolar disorders
  • Major depressive disorders
  • Paranoid disorder
  • Schizophrenia
  • Schizoaffective disorder
  • Stroke
  • Neurologic disorders limited to:
  • Amyotrophic lateral sclerosis (ALS)
  • Epilepsy
  • Extensive paralysis (i.e., hemiplegia, quadriplegia, paraplegia, monoplegia)
  • Huntington’s disease
  • Multiple sclerosis
  • Parkinson’s disease
  • Polyneuropathy
  • Spinal stenosis
  • Stroke-related neurologic deficit

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