Chronic Special Needs Plans: Medicare Advantages’ Largest Growing Plan Type
In 2025 enrollment into one specific type of Medicare Advantage plan outpaced growth in all other plans according to the Kaiser Family Foundation[1]. I am talking about enrollment in Chronic Special Needs plans (C-SNPs). These plans are designed for individuals with certain chronic health conditions such as diabetes or cardiovascular diseases. These plans limit enrollment to people with confirmed diagnoses. In this article I will outline why these plans are growing in number and the benefits of joining one.
To truly understand why C-SNPs are growing so much you must understand a little bit about how the Medicare Advantage program works. To put it simply, Medicare Advantage plans receive a monthly payment per enrollee from the federal government to provide Medicare-covered services. One important caveat to this is that the law requires CMS to adjust payments to Medicare Advantage plans for certain demographic characteristics and the health status of enrollees[2]. This means that Medicare is required by law to pay Medicare Advantage Plans more the sicker their members are. Now that we have basic understanding about why more companies are offering C-SNPs, let us examine the benefits people get for joining one.
Medicare Advantage plans get paid more sicker members so, what do the companies do with all that extra money. First, is that since these plans limit enrollment only to people who have specific health conditions, the plans are tailored to treat that condition. This includes having lower copayments for higher cost medications that are effective in treating specific conditions. Second, plans also include a higher level of care management for each member assisting in coordination of care. Lastly, with the extra money the plans are given they are able to offer more robust benefits. These benefits include a higher over-the-counter allowance with the ability to use the allowance to pay for groceries, utilities, and home safety devices (such as grab bars for shower).
Chronic Specials Need Plans (C-SNP) are one of the fastest growing types of Medicare Advantage plans. In this article we outlined the biggest reason for the growth in C-SNPs being offered and the increase of enrollment into them. These plans allow companies to get paid more for their members and enable members access to a health plan tailored to their needs. With any Medicare Advantage plan you must verify that your medical providers are in network, your medications are covered, and that they have the benefits you need the most. Our dedicated team can help with all these concerns.
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[1] https://www.kff.org/medicare/a-closer-look-at-the-growing-role-of-special-needs-plans-in-medicare-advantage/
[2] https://www.kff.org/medicare/how-medicare-pays-medicare-advantage-plans-issues-and-policy-options/