Medicare Advantage Plans (MAPD) for those with specific chronic conditions
Skip to the bottom of this page for a PDF document containing charts of available plans and detailed information.
Chronic-Specialized Needs Plans (C-SNP) are Medicare Advantage plans available to all individuals who have Medicare Parts A and B with specified severe or disabling chronic conditions. The chronic conditions are Diabetes, Cardiovascular Disorder and Congestive Heart Failure.
All plans are required to verify the applicant’s special needs status. Medicare provides a Special Enrollment Period for individuals who meet the medical criteria established by the Plan. That is all year long except for a short period at the end of the Annual Enrollment period each Fall. Those enrolled in a Special Needs Plan but who are no longer eligible because they no longer meet the specific special needs status will also get a Special Enrollment Period to switch to a regular Advantage plan. The plan must send the appropriate notice to the beneficiary explaining their disenrollment.
These plans are Health Maintenance Organizations — HMO’s. This means you must use the network providers. Plans contract with physician groups and hospitals listed in this chart. Primary Care Providers must refer you to specialists, and those must be within the same physician network. You cannot use medical services outside the network, except for emergencies.
Important for All Plans
Always verify coverage details with the Medicare Advantage Plan, including if your preferred physician(s) and hospital are in the plan’s network. Primary Care Physician and Specialists must refer to providers in the same medical group.
Joining a Plan
In addition to the Special Enrollment option when diagnosed with a qualifying condition, if you have Medicare Parts A & B, you may join any of these plans during the Annual Enrollment Period (October 15 to December 7 each year). Coverage starts January 1 of the following year. If you are new to Medicare, you may join during the 7-month period around your eligibility date (usually 65th birthday). There is also a 2-month special enrollment period if your circumstances change significantly, such as losing your employer coverage or moving. When you enroll, your prior Medicare Advantage or Prescription Drug plan will automatically be canceled when the new plan is effective.
More Information about Available Plans
A PDF file on this topic, including a chart of plans available this year, can be found in the following link. You may view, print, or download our PDF document Special Needs Plans: C-SNPs for Chronic Conditions.
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