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learn the difference between Medicare D-SNP and C-SNP

Medicare Advantage: D-SNP vs. C-SNP

If you’re diagnosed with a severe chronic illness or fall into a specific category of patients, you may be able to enroll in a Special Needs Plan. Special Needs Plans (SNPs) offer specialized benefits for people who are afflicted with certain illnesses and conditions. There are a few types of SNPs currently available, including D-SNPs and C-SNPs. Here’s how the two are different.

What Is A Special Needs Plan

Medicare Advantage contracts with the Medicare administration to provide their members with Medicare benefits. Because they are privately operated companies, they have more flexibility in the level of benefits they are able to offer their members. Special Needs Plans are Medicare Advantage plans that offer specialized services to people who meet certain criteria. Oftentimes, Special Needs Plans only accept members who have been diagnosed with a specific illness or people who have recently experienced life events. 

Types Of Special Needs Plans

There are a variety of Special Needs Plans. Chronic Condition SNPs (C-SNPs) are for people who suffer from chronic conditions, while Dual Eligible SNPs are specifically for individuals who are eligible for both Medicare and Medicaid. While both are SNP categories, the eligibility requirements are entirely different. There are also I-SNPs, which are available to people who live within an institution. Here are some more details about each SNP category. 

Chronic Condition SNPs (C-SNPs)

C-SNPs are geared primarily toward individuals who suffer from severe chronic conditions. Some of the conditions that warrant a C-SNP include HIV/AIDS, stroke, End-Stage Renal Disease, neurologic disorders, dementia, diabetes, and cancer. 

Dual Eligible SNPs (D-SNPs)

Some people are able to qualify for both Medicaid and Medicare at the same time. These individuals are referred to by insurance professionals as “dual eligible”. Dual eligible Medicare enrollees have the option to enroll in SNPs that are designed to provide them with both their Medicare and Medicaid benefits simultaneously. 

Policy Structure For SNPs

Although it’s possible that they may be neither, Special Needs Plans are often either Health Maintenance Organization (HMO) plans or Preferred Provider Organization plans. The difference is important, as the structure of your plan will determine important factors like whether you will need a referral to see specialists and whether you can receive care outside of a strict network. 

Find An SNP – Work with TSS

Find out if you’re eligible for a Special Needs Plan. Speak with the insurance professionals at Trusted Senior Specialists to learn more. You can contact us now to schedule a consultation.