Chronic Conditions

This FAQ (Frequently Asked Questions) answers common questions about chronic conditions and how they are managed within Medicare.

Chronic Conditions

What is a Chronic Condition?

Chronic conditions are long-lasting medical conditions e.g. diabetes. The following are listed as chronic conditions by CMS:

  • Alzheimer’s disease,
  • Arthritis,
  • Asthma,
  • Atrial Fibrillation,
  • Autism,
  • Cancer (breast, colorectal, lung and prostate),
  • Chronic kidney disease,
  • Chronic obstructive pulmonary disease (COPD),
  • Depression,
  • Diabetes,
  • Heart failure,
  • Hepatitis (chronic viral B & C),
  • HIV/AIDS,
  • Hyperlipidemia (high cholesterol),
  • Hypertension,
  • Ischemic heart disease,
  • Osteoporosis,
  • Schizophrenia, and
  • Stroke.

 

What impact does this have on my Medicare coverage?

People with chronic conditions may enroll in the usual Medicare plans, but those treatment options may not offer the coverage they need on a long-term basis.

Recognizing the need to offer different treatment options for chronic conditions, there are Special Needs Plans for specific Chronic Conditions (C-SNPs) which are targeted towards people suffering from one or more chronic conditions. SNPs are Medicare Advantage (MA) Plans which also include drug coverage and typically some additional benefits.

Those who are institutionalized or are dual-eligible may enroll in SNPs targeted towards them (I-SNPs and D-SNPs respectively).

What difference does this make to my Enrollment periods?

One can enroll in an SNP at any time during the year, but the plan may need proof of the chronic condition within a month of enrolling. Failure to provide proof may result in dis-enrollment from the SNP.

Is there any impact on my share of Medicare costs?

Private SNPs vary widely in plan costs and coverage. Apart from an additional premium, cost-sharing may include plan deductibles, coinsurance and copays.

Make sure to compare plans and select the one that best meets your needs. Financial assistance may be available to those who qualify.

What types of Plans are good for people with ‘Chronic Condition(s)’?

There are 15 types of chronic condition SNPs. Pick the one which fits your condition as you will have to prove that you qualify for enrollment into that SNP. Remember that SNPs are not available everywhere.

                                                                                                                                                  

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Remember that you cannot choose just any combination of Parts and Plans. Let Lighted Road Insurance guide you step-by-step through the Medicare ecosystem and help you in selecting the right plan(s) for your needs.