
Chronic Special Needs Plan (CSNP) Opportunities
Written by Rachel Brammeier
If a CSNP is available in the client’s service area, check the plan details for the criteria of the chronic condition to see the client’s eligibility into that plan. The most common eligible conditions are heart problems and diabetes.
Confirmation of the client’s chronic condition is needed from their primary care physician (PCP) for enrollment in the plan. Check the plan for the appropriate forms needed and ensure that the physician’s office has also been sent the form.
If the client is eligible, the client has a one time Special Enrollment Period (SEP) election to enroll. Enrollment will begin on the first day of the month after receipt of the election.
Election Code: SEP – Special Need/Chronic
According to research done by the National Council on Aging (NCOA), nearly 95% of adults 60 and older have at least one chronic condition, while nearly 80% have two or more.
In addition, research from KFF showed that 44% of Medicare-Medicaid Enrollees reported a ‘fair’ or ‘poor’ health status in 2020.
CSNPs are designed with extra benefits specifically for those with chronic conditions.
With the Dual Special Needs Plan (DSNP) changing in 2025, your dual status client may qualify for a CSNP.
For more information, please call us today at (800) 689-2800!
https://www.kff.org/medicare/issue-brief/a-profile-of-medicare-medicaid-enrollees-dual-eligibles/
https://www.medicare.gov/health-drug-plans/health-plans/your-coverage-options/SNP
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6873710/
https://www.ncoa.org/article/the-top-10-most-common-chronic-conditions-in-older-adults/
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