Chronic condition special needs plans (C-SNPs) are a specialized type of Medicare Advantage (MA) plan. Medicare Advantage is a government-sponsored program offering an alternative to fee-for-service Medicare, where benefits are provided to beneficiaries by Medicare Advantage organizations (MAOs).

This paper discusses the market landscape and considerations for C-SNPs, which focus on beneficiaries with specific chronic conditions. The Centers for Medicare and Medicaid Services (CMS) defines eligible beneficiaries as individuals who have one or more comorbid and medically complex chronic conditions that are substantially disabling or life-threatening, have a high risk of hospitalization or other significant adverse health outcome, and require specialized delivery systems across domains of care. CMS allows for 24 different chronic conditions as defined in the plan benefit package that an MAO must complete when filing a plan with CMS.

Key takeaways from the paper include the following:

• Market growth: C-SNPs grew significantly from 2023 to 2026, in both the number of plans and beneficiary enrollment.
• Most common conditions: The most prevalent C-SNP types target diabetes mellitus, chronic heart failure, and cardiovascular diseases; all other C-SNP types are relatively uncommon.
• Member premiums: While premiums vary, the most frequently offered member premium in 2026 is $0, which is consistent with general enrollment MA plans.
• Formulary select tiers: More than 50% of C-SNPs in 2026 offer a formulary with a tier for select drugs, which allow plans to offer specific cost sharing on drugs relevant to targeted chronic conditions.
• SSBCI benefits: Special Supplemental Benefits for the Chronically Ill (SSBCI) are frequently offered by C-SNPs in 2026, with food and produce, and general living supports, among the most common offerings.