Chronic Conditions & Medicare - Special Needs for Medicare Beneficiaries - Healthpocket

Chronic Conditions & Medicare

Chronic conditions are medical conditions that last over a year and require ongoing medical attention and can limit the daily activities of those suffering from them. Alongside the physical and emotional toll chronic conditions bring, they also bring additional financial burdens in the form of out-of-pocket costs for medications and physician care.

Over half of all consumers eligible for Medicare are treated for multiple chronic conditions. ( )The below table illustrates how common various chronic conditions are among Medicare enrollees:

Chronic Condition:Percentage of All Medicare Fee-For-Service Beneficiaries With Condition in 2011
Alzheimer's Disease/ Dementia11.0%
Atrial Fibrillation (Irregular Heartbeat)8.0%
Chronic Kidney Disease15.3%
Chronic Obstructive Pulmonary Disease11.5%
Heart Failure15.6%
Hyperlipidemia (High Cholesterol)45.0%
Hypertension (High Blood Pressure)56.5%
Ischemic Heart Disease30.3%
Rheumatoid Arthritis29.3%

Chronic Conditions & Health Plan Quality

The Centers for Medicare & Medicaid Services (CMS) gather data on the effective management of various chronic conditions by Medicare plans. HealthPocket uses this data to personalize their Quality Ratings on Medicare plans when the user indicates that he or she has one of the chronic conditions tracked by CMS. By using the Medicare plan comparison tool on HealthPocket, you can see how this personalization works as well as review the underlying data on the Plan Details page for a given Medicare insurance plan.

Special Needs Plans for Chronic Conditions

The U.S. Department of Health and Human Services has a variety of initiatives aiming to reduce the burden of multiple chronic conditions for patients as well as reduce the costs associated with treating these conditions. Among these initiatives are Medicare Advantage Special Needs Plans that focus on the care of individuals with a specific chronic condition. These Chronic Condition Special Needs Plans (C-SNPs) are health insurance plans that limit enrollment to individuals that have the particular chronic condition managed by the plan.

C-SNPs are not available in every region due to the fact that they require a network of health care providers that are suited to care of the chronic condition they serve. Eligibility for C-SNPs must be confirmed with the applicant’s healthcare provider and must be reconfirmed at least once a year. The programs are designed to bring more effective care to individuals suffering from a particular chronic condition.

These health plans utilize doctors and facilities that specialize in the treatment of a particular chronic condition (e.g. diabetes) and have formularies (i.e. a list of covered drugs) that include the medications associated with the treatment of the chronic condition.

Below is a list of those chronic conditions for which a C-SNP may be available.

  • Alcohol and drug dependence
  • Auto-immune disorders
  • Cancer (excluding pre-cancer conditions)
  • Cardiovascular disorders
  • Chronic heart failure
  • Dementia
  • Diabetes mellitus
  • End-stage liver disease
  • End-Stage Renal Disease (ESRD)
  • Severe blood disorders
  • Chronic lung disorders
  • Chronic and disabling mental health conditions
  • Neurologic disorders
  • Stroke

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