The Prominence Chronic Special Needs Plan (CSNP) Heart Plan is specifically designed for individuals diagnosed with certain chronic conditions, primarily related to the cardiovascular system and diabetes. However, to ensure the plan meets the specific needs of the patient, perspective members need to meet certain eligibility requirements to apply. Here are the eligibility requirements for a Prominence CSNP Heart Plan.
1. Medicare enrollment
Since the Prominence CSNP Heart Plan is a part of Medicare, it only makes sense that members need to be enrolled in Medicare to apply. To be eligible for a Prominence CSNP Heart Plan, individuals must be enrolled in both:
- Medicare Part A (Hospital Insurance)
- Medicare Part B (Medical Insurance)
Maintaining active Medicare coverage is necessary for continued enrollment in a CSNP Heart Plan. If you lose Medicare coverage, you’ll also lose CSNP eligibility.
2. Reside in the Plan’s service area
A Prominence CSNP Heart Plan isn’t available nationwide. You must reside in the coverage area to receive the benefits. Only individuals who reside in Washoe County, Nevada are eligible, which includes:
- Reno
- Sparks
Proof of residency is required to apply for a Prominence CSNP Heart Plan, typically in the form of a government ID, mortgage deed or rental agreement, pay stub, or utility bill.
3. Meet all CSNP Heart Plan qualifications
As the CSNP Heart Plan is designed specifically for individuals with specific conditions, the plan is limited to only those with one or more of the following chronic conditions:
- Heart Attack
- Pacemaker
- Atrial Fibrillation (AFib)
- Blockage
- Blood Clots
- Congestive Heart Failure
- Coronary Artery Disease
- Heart Rhythm Problems
A licensed healthcare provider must confirm the diagnosis with appropriate medical documentation. Prominence may also reach out to your physician for a completed Health Risk Assessment or statement of diagnosis as part of the enrollment process.
4. Enroll during an eligible period
Just like any other health insurance plan, you may only enroll in a Prominence CSNP Heart Plan during a valid Medicare election period. There are only a few periods per year:
- Initial Coverage Election Period (ICEP): when you become eligible for Medicare.
- Annual Enrollment Period (AEP): October 15 through December 7
- Special Enrollment Period (SEP): triggered by certain qualifying events, such as a diagnosis with a chronic condition, change of residence, or loss of other coverage.
If you’re not sure when you may qualify for the Initial Coverage Election Period or Special Enrollment Period, reach out to an agent at Health Benefits Associates, so we can discuss your options.
5. Verify diagnosis
The final eligibility requirement for a Prominence CSNP Heart Plan is to verify your diagnosis. Because this is a condition-specific plan, Prominence needs to a medical verification of your qualifying chronic condition. They may reach out to your healthcare provider directly to confirm and verify your diagnosis before your enrollment can be approved.
Find your best healthcare fit with Health Benefits Associates
Having a chronic condition requires regular, specialized care. And the Prominence CSNP Heart Plan is ideal for qualified individuals with chronic conditions. If you’re unsure whether you qualify, or just want more information on the plan benefits, contact us at Health Benefits Associates. Our trained agents can walk you through the process to apply and find the perfect health insurance option for your specific needs. Schedule an appointment by calling 775-828-1216 today.