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D-SNPs and C-SNPs are both Medicare Advantage Special Needs Plans, but they serve different groups of Medicare beneficiaries.
D-SNP: eligibility is based primarily on Medicare plus qualifying Medicaid eligibility. C-SNP: eligibility is based on having a qualifying severe or disabling chronic condition served by that plan.
Qualifying chronic condition
| Feature | D-SNP | C-SNP |
|---|---|---|
| Full name | Dual Eligible Special Needs Plan | Chronic Condition Special Needs Plan |
| Primary eligibility | Medicare + qualifying Medicaid eligibility | Qualifying chronic condition |
| Medicare Advantage plan | Yes | Yes |
| Includes Part D | Yes | Yes |
| Specialized care coordination | Yes | Yes |
| Medicaid coordination | Central feature | Not required |
| Chronic-condition focus | May vary | Central feature |
| Availability | Depends on area | Depends on area |
| Must continue qualifying | Yes | Yes |
D-SNP stands for Dual Eligible Special Needs Plan. It serves people who qualify for Medicare and also have qualifying Medicaid eligibility.
The defining feature is coordination between Medicare and Medicaid—not simply “more benefits.” Medicaid categories and support can differ by state.
C-SNP stands for Chronic Condition Special Needs Plan. Enrollment is restricted to people who meet the plan’s qualifying chronic-condition rules.
Having any chronic condition does not automatically qualify you. The plan must serve the condition and eligibility must be established under its rules.
Diabetes • Chronic heart failure • Certain cardiovascular disorders • Cancer • Certain chronic lung disorders • Dementia • HIV/AIDS • Neurological disorders • ESRD requiring dialysis • Stroke • Certain autoimmune and hematologic disorders
C-SNP eligibility is tied to specific qualifying medical conditions.
Medicare status + qualifying Medicaid eligibility + local plan availability.
Qualifying severe or disabling chronic condition + plan serving that condition + local availability.
If you’re considering a plan because of a particular doctor or specialist, don’t rely on the plan type alone.
SNPs can operate as HMO, HMO-POS or PPO plans, so network flexibility should be checked separately.
Especially important when managing serious or complex conditions.
Don’t verify only the PCP.
A specialized plan still needs to handle essential prescriptions appropriately.
Compare the medical services you are most likely to use.
Review how the plan helps manage physicians, Medicaid programs and chronic care.
Dental, vision, food, transportation and other extras come after doctors, drugs and core medical coverage.
Usually the better first question is: Which plans am I actually eligible for, and which eligible plan works best with my healthcare?
You have Medicare and qualifying Medicaid eligibility and want a plan structured around coordinating those benefits.
You have a qualifying severe or disabling chronic condition and a C-SNP serving that condition is available where you live.
In either case, the plan still needs to work with your doctors, medications, hospital system and healthcare needs.
A D-SNP is designed for people with Medicare and qualifying Medicaid eligibility. A C-SNP is designed for people with specified severe or disabling chronic conditions.
No. C-SNP eligibility is based on the qualifying chronic condition and other plan eligibility requirements, not Medicaid eligibility.
D-SNP eligibility centers on qualifying for Medicare and applicable Medicaid eligibility rather than having a particular chronic illness.
Yes. Medicare requires Special Needs Plans to include Part D coverage.
Yes. Diabetes mellitus is one of the chronic conditions CMS recognizes for C-SNP purposes, although plan availability and enrollment requirements vary.
Medicare Plan Assistance can help determine which Medicare plan types are available in your area and help you review eligibility, doctors, prescriptions and coverage considerations.
Helping make Medicare easier to understand.
Independent Medicare Guidance
Medicare Plan Assistance is an independent insurance agency and is not Medicare, Medicaid or a government agency.
D-SNP and C-SNP eligibility, availability, provider networks, formularies, care coordination, benefits, cost sharing and plan rules vary by state, county, insurer and individual plan.
Before enrolling, review the exact plan’s Summary of Benefits, Evidence of Coverage, Provider Directory, Drug Formulary and applicable eligibility requirements.