Chronic Condition Special Needs Plans (C-SNPs)

To qualify for an Aetna C-SNP, your provider will need to verify you have at least one of the following conditions:

• Diabetes Mellitus (high blood sugar)
• Chronic Heart Failure (CHF) (heart is unable to pump blood as it should)
• Cardiac arrhythmias (irregular heartbeats)
• Coronary artery disease (blocked blood vessels in the heart)
• Peripheral vascular disease (poor circulation in the arms and legs)
• Valvular heart disease (damage of flaps in the heart that control blood flow)

An Aetna C-SNP is only for Medicare members with at least one of these eligible conditions. We have to check and make sure that all new members have at least one of these conditions. If we find that a member has enrolled in a C-SNP but does not have one of these conditions, we must disenroll that member.

What if I don’t have an eligible condition and I enroll in a plan? 

An Aetna C-SNP is only for Medicare members who have at least one eligible chronic condition. If you enrolled and don’t have one of these conditions, you'll be removed from the plan by the end of the second month. 

You can speak with a licensed Medicare agent. They can walk you through the steps to enroll.

As part of the enrollment application, you’ll need to complete a form that covers the details of your condition. This form is called the Prequalification Assessment Tool (PQAT).

Then, we’ll send a verification of chronic condition (VCC) form to your provider. Your provider will verify that you have that eligible chronic condition and that you qualify for a C-SNP. Your health care provider must respond by the end of your second month enrolled in the plan.

Get more details on how to enroll here.

Initial Enrollment Period (IEP) 

You can enroll in a C-SNP the first time you enroll in Medicare. Your IEP is open for 7 months. Usually, 3 months prior to the month you turn 65, the month you turn 65 and 3 months after you turn 65. 
 

Annual Enrollment Period (AEP) 

You can also enroll every year during the Medicare AEP. AEP begins on October 15 and ends on December 7. 
 

Special Enrollment Period (SEP) 

A Medicare Special Enrollment Period (SEP) is a special time that you can sign up for or make changes to your C-SNP — even if it’s not during the usual Medicare enrollment times.

There are certain rules for SEPs:
 

• If you get a new chronic condition that’s not covered on your C-SNP, you’ll get a new SEP. Then you can enroll in another C-SNP that will help you manage that condition.

• You only get one SEP for each new condition that qualifies.

• After you join a C-SNP for your new condition, the SEP ends.

It’s important that your doctor lets us know about your chronic condition by the end of your second month active on the plan. If that doesn't happen, you'll be removed from the plan by the end of the second month. But don’t worry, you will get an SEP of 60 days to enroll in a different Medicare plan, like MA, MAPD, or PDP.

Speak with a licensed Medicare agent. They can help you decide when to enroll.

An Aetna C-SNP pairs each member with a team of health care professionals. Your care team works with you and your providers to develop your care plan. And they connect you with programs to help beyond health care services.

Your care team understands your plan benefits and helps you access the ones you need. If you want, they can schedule medical and dental appointments for you.

They can also connect you with local and state programs and resources to help you with meals, local transportation and more.