If you have a chronic medical condition and are eligible for Medicare, you may be eligible for a special type of Medicare Advantage Plan known as a CSNP (Chronic Special Needs Plans).  This is one of a few types of special needs plans available.  


What are Chronic Special Needs Plans?  (CSNP)

CNSPs are a type of Medicare Advantage Plan (Medicare Part C).  Medicare Part C plans replace original Medicare entirely.  You’ll give up access to the extremely broad Original Medicare network in favor of additional benefits, set copays, and out of pocket maximums.   


What Benefits do CSNP’s Offer?

CSNPs are tailored to meet the needs of your condition.  For example, you might have lower copays to see a specialist often involved in treating your condition.  If you have diabetes, you might have a $20 copay for most specialists, but no copay for an endocrinologist, cardiologist and podiatrist as these specialists are often needed to treat diabetes.  

If you suffer from chronic lung diseases, you might have reduced copays to see a pulmonologist and cardiologist.  Additionally, you might have reduced copays for medications commonly prescribed to treat your condition.  You could even have additional benefits like wellness and exercise programs.  

CSNPs are offered by private carriers so prices and benefits do vary.  But what’s important to note is that the benefits will be tailored to your condition.  So, you may find that these plans are more cost friendly for you than others.  It’s a complex situation.  For this reason, we recommend working with a broker who can find the best plan for you. 

Additionally, because you are giving up the Original Medicare network in favor of your carrier’s network, you need to make sure that the doctors, specialists and hospitals in your area accept your plan.  


Am I Eligible?

In order to be considered eligible for a CSNP, you must be eligible for Medicare plus meet the criteria for your condition and plan. .  


You are eligible for Medicare benefits if:

  • You are over 65 and a U.S. citizen OR you are over 65 and a permanent legal resident who has lived in the United States for at least five years
  • You are receiving social security or railroad retirement benefits OR have worked long enough (40 quarters) to be eligible for benefits even if you are not collecting them yet
  • You are also eligible if you are over 65 and you or your spouse is a government employee or retiree who has NOT paid into social security, but who HAS paid into Medicare payroll taxes while working , meaning a Medicare-covered job.   

If you are under 65, you are eligible for Medicare Parts A & B benefits if:

  • You have received social security benefits for at least 24 months.  These months do NOT have to be consecutive.  So, it is ok, if there are breaks in between, but it must be at least 24 months total.
  • You have ALS
  • You have end-stage renal disease (as of 2021)


Chronic Medical Conditions

There is a very long list of chronic conditions which may make you eligible.  There are 15 categories further divided into subcategories.  There may be additional criteria based on your condition.

  1. Chronic alcohol and other drug dependence
  2. Autoimmune disorders
  3. Cancer
  4. Cardiovascular disorders
  5. Chronic heart failure
  6. Dementia
  7. Diabetes mellitus
  8. End-stage liver disease
  9. ESRD
  10. Severe hematologic disorders
  11. HIV/AIDS
  12. Chronic lung disorders
  13. Mental health conditions
  14. Neurologic disorders
  15. Stroke


How Do I Enroll?

You will need to provide documentation to enroll in a CSNP.  Very often you can enroll in the plan without the documentation, but will need to provide it within a month or risk being dropped.  Your plan will provide specific details. However, very often your doctor will need to provide specific paperwork regarding your overall health and your condition.    

You can enroll in a CSNP during your individual open enrollment or during the annual open enrollment.  Your individual open enrollment is the three months before your turn 65, your birth month and the three months after.   The annual enrollment period is the same time every year from October 15-Dec. 7.  During this time you may join, switch or drop a plan. You may also qualify for a special enrollment period.  If so, you can enroll at that time.  

CSNP’s are a type of Medicare Advantage plan.  So the hospitals and doctors you wish to visit must be in network.  Therefore, they must accept your carrier’s plan.  You can check with your doctor in advance to determine which plans they accept.  Most CSNP’s operate as HMO’s (although there are some PPO options).  HMOs require you to have a designated primary care physician. You can check out all of the options available to you on Medicare.gov.

You may also contact your carrier of choice and work with an agent.   Additionally, you can work with a broker who will help you compare and contrast all the plans available to you.  


How Much Does it Cost?

Your costs for a Special Needs Plan vary dependent upon your plan and carrier.  Although these plans are regulated by Medicare the premiums and copays are determined by the carrier.  You may still have to pay for Medicare Part B plus an additional monthly premium or not at all.  Although the prices and benefits of the plans will vary, if  CSNP is available to you, it’s definitely an option that you will want to research.  

If you’d like our assistance, you can reach us at iHealthBrokers at 888-918-0518 or schedule a call today! Our services are 100% FREE!