English | Español
Medicare Topics
Chronic Condition Special Needs Plans (C-SNP)
A C-SNP is a Medicare Advantage plan built around one or more specific, CMS-approved chronic conditions, such as diabetes or chronic heart failure. Enrollment is limited to people with a qualifying condition, and the plan's benefits and network are tailored around it.
What is a C-SNP?
A Chronic Condition Special Needs Plan is one of three types of Medicare Advantage Special Needs Plan (the others are for dual Medicare/Medicaid eligibility and for people in institutional care). CMS describes C-SNP eligibility as having "one or more co-morbid and medically complex chronic conditions that are substantially disabling or life threatening." Each C-SNP is designed around a specific condition category or categories, not every chronic condition in general.
Which conditions qualify?
CMS recognizes 15 chronic condition categories for C-SNP eligibility:
- Chronic alcohol and other drug dependence
- Autoimmune disorders (rheumatoid arthritis, lupus, and related conditions)
- Cancer (excluding pre-cancer or in-situ conditions)
- Cardiovascular disorders (coronary artery disease, peripheral vascular disease, arrhythmias)
- Chronic heart failure
- Dementia
- Diabetes mellitus
- End-stage liver disease
- End-stage renal disease (ESRD) requiring dialysis
- Severe hematologic disorders (such as sickle cell disease or hemophilia)
- HIV/AIDS
- Chronic lung disorders (asthma, chronic bronchitis, emphysema)
- Chronic and disabling mental health conditions (bipolar disorder, major depression, schizophrenia)
- Neurologic disorders (ALS, epilepsy, multiple sclerosis, Parkinson’s disease, stroke-related deficits)
- Stroke
Source: CMS, Special Needs Plans: Chronic Conditions.
How is a C-SNP different from a regular Medicare Advantage plan?
Every Medicare Advantage plan must cover what Original Medicare covers, but a C-SNP goes further for its specific condition: care coordination is usually more intensive, the provider network may be built around specialists for that condition, and the drug formulary can be tailored to medications commonly needed for it. In exchange, enrollment is restricted, you generally cannot join a C-SNP without a qualifying condition confirmed at enrollment.
If you are not sure whether your own diagnosis matches one of the 15 categories above, or whether it is specific enough (for example, high cholesterol alone does not automatically qualify, but certain cardiovascular disorders do), a licensed agent can check a specific plan's intake criteria with you.
How do I prove I qualify?
Plans typically verify your condition through a health assessment at enrollment, sometimes followed up with confirmation from your doctor. If a plan cannot verify your condition after you join, it can disenroll you, so it's worth being accurate and specific about your diagnosis when you apply, not just close to it.
Is a C-SNP available where you live?
C-SNP availability varies a great deal by county, a plan built for diabetes might exist in one county in our service area and not in a neighboring one. Check your own county's current C-SNP availability on its guide below, or call us with your ZIP code and condition and we'll check for you.
Common questions about C-SNPs
What is a C-SNP?
A Chronic Condition Special Needs Plan is a type of Medicare Advantage plan limited to people with one or more specific, CMS-approved chronic conditions. CMS describes eligibility as having "one or more co-morbid and medically complex chronic conditions that are substantially disabling or life threatening."
Which conditions qualify for a C-SNP?
CMS recognizes 15 chronic condition categories, including diabetes, chronic heart failure, cardiovascular disorders, chronic lung disorders, dementia, cancer, and several others listed on this page. A plan only has to cover the specific condition category or categories it is designed for.
How is a C-SNP different from a regular Medicare Advantage plan?
Enrollment is restricted to people with a qualifying condition, confirmed by a doctor or health assessment when you apply. In exchange, the plan’s benefits, provider network, and sometimes its drug formulary are built around that condition, often with extra care coordination.
How do I prove I qualify for a C-SNP?
The plan verifies your condition, usually through a health assessment at enrollment, sometimes confirmed afterward by your doctor. If the plan cannot verify a qualifying condition, it can disenroll you, so accuracy matters when you apply.
Is a C-SNP available where I live?
It depends on your county. C-SNP availability varies a great deal across our San Antonio-area service counties, see your own county guide for the current count, or call us and we will check for your specific condition and ZIP code.
Can I leave a C-SNP if it stops working for me?
Yes. You can switch during the Annual Enrollment Period (October 15 to December 7) or, if you no longer have the qualifying condition, you may also qualify for a Special Enrollment Period to change plans outside of that window.
Sources
Figures verified 2026-10-01.