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Chronic Illness Special Election Period

Medicare beneficiary with a chronic illness

Medicare is a valuable resource that provides health insurance coverage to millions of Americans. For individuals with chronic conditions, Medicare offers additional support through Chronic Special Needs Plans (CSNPs). These plans cater specifically to the unique healthcare needs of individuals living with chronic illnesses. To make access to CSNPs readily available, Medicare offers a Chronic Illness Special Election Period that allow qualified individuals to enroll or make changes outside of the regular enrollment periods. Continue reading to learn more about:

Understanding Chronic Special Needs Plans (CSNPs)

Chronic Special Needs Plans (CSNP) are a type of Medicare Advantage plan that help address the needs of beneficiaries living with chronic conditions. These plans are designed to offer comprehensive care management, coordination, and specialized resources for individuals with specific chronic illnesses such as diabetes, heart disease, and chronic obstructive pulmonary disease (COPD). They must offer Medicare prescription drug coverage (Part D), and often offer additional benefits such as routine vision, and dental care.

Chronic Illness Special Election Period

The Chronic Illness SEP is a specific time frame outside of common Medicare election periods, such as the Annual Election Period (AEP), where you can change your current Medicare coverage and join a CSNP. This SEP is available to you at any time during the year if you meet the following qualifications:

  • Have Medicare Part A and Part B
  • Live in the plan’s service area
  • Meet the eligibility requirements for the Chronic Condition SNP (C-SNP)
Common examples of chronic conditions may include:
  • Diabetes
  • ESRD
  • Certain cardiovascular disorders
  • Certain chronic lung disorders

What changes can be made during the SEP?

When eligible, the Medicare Special Election Period (SEP) allows you to make the following changes to your Medicare coverage including:

  • Switching from Original Medicare to a C-SNP
  • Changing from one Medicare Advantage Plan to a C-SNP

How long does the SEP last?

The Medicare Special Election Period (SEP) for chronic conditions is not a fixed duration. As long as you have the qualifying condition you can join a Chronic Special needs Plan, the election period ends once you enroll in a C-SNP.

Chronic Illness SEP Example:

Ruth who is currently on a Medicare Advantage plan, was diagnosed with diabetes. When talking to her friend Carl about her diagnosis, he told Ruth about chronic special needs plans. Ruth contacts her insurance agent and learns she has the option to use the Chronic Illness SEP to enroll in a C-SNP that includes diabetes as a qualifying chronic illness. Ruth and her agent look over her options to find a chronic special needs plan that works well for her, and she enrolls in the plan.

What to consider before enrolling in a plan:

There are a few things to consider when deciding if you want to enroll in a CSNP and which plan to choose. Our friendly, licensed agents can assist you through the process! You will want to:

  • Review your current healthcare needs: Assess your chronic condition and consider any changes or additional coverage you may require.
  • Research available options: There may be multiple carriers that offer chronic special needs plans in your service area, and they can offer different additional benefits.
  • Make sure your doctors and prescription drugs are covered: networks and drug formularies can vary amongst carriers, so it is important to check that your current providers and prescriptions are going to be covered.

If you have a chronic condition, C-SNPs can play a significant role connecting you with specialized care and support beyond what original Medicare provides. With the Chronic Illness SEP, you can enroll or switch to a CSNP that better caters to your unique healthcare needs.

Are you ready to compare plans? Contact us here so our friendly, licensed agents can help you navigate your options. Learn about the Benefits of Using an Independent Licensed Agent for your Medicare coverage.

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