Florida Blue's New Focus C-SNP: How to Sell It
Who qualifies, what the plan includes in each county, how verification works, and the agent toolkit to sell it
Plenty of your clients live with diabetes, heart failure, or a cardiovascular condition and don't qualify for Medicaid. A D-SNP isn't an option for them, but a plan built around their condition could be.
For 2027, Florida Blue Medicare is launching BlueMedicare Focus (HMO C-SNP), a $0-premium Chronic Special Needs Plan with a Part B giveback, built for beneficiaries with qualifying chronic conditions in nine Florida counties. The catch is verification: a client's doctor has to confirm their condition after enrollment, so setting expectations at the table is part of selling it well.
Who Qualifies
Clients must be eligible for and enrolled in Medicare Parts A and B, live in the plan's service area, and have a verifiable qualifying chronic condition. Medicaid is not required.
Qualifying conditions:
Diabetes mellitus
Chronic heart failure
Cardiovascular disorders (cardiac arrhythmias, coronary artery disease, peripheral vascular disease, and chronic venous thromboembolic disorder)
Service area: Lake, Marion, Sumter, Palm Beach, Charlotte, Collier, Lee, Manatee, and Sarasota counties.
Enrollment is available year-round through applicable Medicare enrollment periods, including IEP, AEP, OEP, and SEP for new or existing diagnoses.
2027 Plan Highlights by County
All three plans have a $0 premium, $0 deductible, $0 PCP and $15 specialist copays, $0 copays on Tier 1, 2, and 6 drugs, a $2,400 Part D out-of-pocket max, vision and hearing coverage, SilverSneakers, HealthyBlue Rewards, and the Premier network. Here's what changes by county:
How Verification Works
Every application needs a completed Pre-Enrollment Qualification Assessment Tool (PQAT) form, where the client declares their qualifying condition and lists their provider. Without a complete PQAT, the application will be denied.
After enrollment, the client is active on the plan and receives all benefits. Florida Blue's enrollment team reaches out to the provider by fax and email within days of receiving the application, and the condition must be verified within 30 days of enrollment. You can track status in the Agent Portal status report, where pending cases show as "pending-PQAT."
Send completed PQAT forms by email to [email protected] or by fax to 904-301-1944.
What Members Get After Enrolling
Every C-SNP member is assigned an interdisciplinary care team, with a registered nurse case manager as their primary contact. The team completes a Health Risk Assessment within 90 days of enrollment, builds an individualized care plan, coordinates appointments and referrals, and follows up within 24 to 48 hours after a hospital discharge. Members also get a face-to-face visit within the first 12 months.
Common Questions
Your C-SNP Toolkit
For you (agent only):
C-SNP Focus Deep Dive Deck: Plan overview, verification timeline, Model of Care, and qualifying ICD-10 codes
Getting Started C-SNP Job Aid: Eligibility, key features, and FAQs
For your clients:
PQAT Form: Required with every C-SNP application
C-SNP Agent Flyer: Walks new members through their first 90 days. You can customize it with your contact information in ODS.
Enrollment Guides: Summary of Benefits and enrollment forms for each county
