Chronic Condition Special Needs Plans (C-SNP) and ESRD

What a C-SNP is

A C-SNP is a type of Medicare Advantage (Part C) plan. Like other Medicare Advantage plans, it is offered by a private insurance company approved by Medicare and covers everything Original Medicare Parts A and B cover. What makes it different is who can join: each C-SNP is designed for people with one chronic condition, or a related group of conditions, and its doctors, benefits and drug list are chosen with that condition in mind.

A plan may serve a single condition, such as diabetes, or a group of conditions that often occur together. Medicare accepts five groupings: diabetes and chronic heart failure; chronic heart failure and cardiovascular disorders; diabetes and cardiovascular disorders; diabetes, chronic heart failure and cardiovascular disorders; and stroke and cardiovascular disorders.

Who qualifies for a C-SNP

To join a C-SNP you must:

• have Medicare Part A and Part B,
• live in the plan’s service area, and
• have a chronic condition the plan is designed for.

Medicare limits C-SNPs to the 15 chronic conditions below. Where a category names specific diagnoses, only those diagnoses count.

• Chronic alcohol and other drug dependence
• Autoimmune disorders: polyarteritis nodosa, polymyalgia rheumatica, polymyositis, rheumatoid arthritis and systemic lupus erythematosus
• Cancer, not including pre-cancer conditions or in-situ status
• Cardiovascular disorders: cardiac arrhythmias, coronary artery disease, peripheral vascular disease and chronic venous thromboembolic disorder
• Chronic heart failure
• Dementia
• Diabetes mellitus
• End-stage liver disease
• End-stage renal disease (ESRD) requiring dialysis
• Severe hematologic disorders: aplastic anemia, hemophilia, immune thrombocytopenic purpura, myelodysplastic syndrome and sickle-cell disease (not sickle-cell trait)
• HIV/AIDS
• Chronic lung disorders: asthma, chronic bronchitis, emphysema, pulmonary fibrosis and pulmonary hypertension
• Chronic and disabling mental health conditions: bipolar disorders, major depressive disorders, paranoid disorder, schizophrenia and schizoaffective disorder
• Neurologic disorders: amyotrophic lateral sclerosis (ALS), epilepsy, extensive paralysis, Huntington’s disease, multiple sclerosis, Parkinson’s disease, polyneuropathy, spinal stenosis and stroke-related neurologic deficit
• Stroke

A few points people often ask about: COPD counts when it is diagnosed as chronic bronchitis or emphysema. High blood pressure on its own is not one of the listed conditions, and chronic kidney disease counts only once it is end-stage and requires dialysis. Not every condition has a C-SNP in every area, and each plan accepts only the condition or conditions it was approved to serve.

How your condition is confirmed

Before or shortly after you join, the plan must confirm your qualifying condition with your doctor. If the plan cannot confirm it, you will be disenrolled from the C-SNP, so it helps to know which doctor treats the condition and to have your diagnosis on record.

C-SNP benefits

Every C-SNP must include Part D prescription drug coverage. Beyond that, benefits differ from plan to plan. Depending on the plan, they can include:

• a provider network that includes specialists who treat the plan’s target condition,
• care coordination and disease management programs,
• lower copays for services and drugs related to the condition,
• supplies tied to the condition, such as glucose monitors and testing supplies in a plan for diabetes,
• an allowance for over-the-counter items, and
• rides to medical appointments.

Some extra benefits, such as allowances for healthy food or utilities, are offered only to members who meet the plan’s chronic illness requirements for that benefit. Check each plan’s Summary of Benefits for exactly what it covers and what it costs.

How a C-SNP coordinates your care

Medicare requires every Special Needs Plan to follow a model of care. Under that rule the plan must:

• complete a health risk assessment of your physical, psychosocial and functional needs when you join, and repeat it every year,
• develop an individualized care plan with you, with goals and the services you will receive, and
• manage your care through an interdisciplinary care team.

Many plans assign a care coordinator who helps with your treatment plan, your medicines, specialist referrals and preventive care. That help matters most when a condition involves several doctors.

Sources: CMS, Chronic Condition Special Needs Plans, list of SNP-specific chronic conditions (page updated September 10, 2024); CMS Medicare Managed Care Manual, Chapter 16b, sections 40.7.3 (condition groupings), 50.2.3 (verification) and 80.1 (Part D); 42 CFR 422.101(f) (model of care).

Browse the plan data this guide relates to: Medicare plans for 2027 · Florida · Georgia · Texas.

Researched and reviewed by Jordan Diaz, Licensed Insurance Agent, NPN 18910035, Senior Benefit Assistance. This page does not display plan data; the plan figures elsewhere in this section come from CMS’s published CY2027 Landscape Source File, data as of October 18, 2026. Last reviewed: November 5, 2026.