CSNP vs. DSNP
Key Takeaways
- Special Needs Plans are Medicare Advantage plans designed by private insurance carriers for people who meet the eligibility requirements:
- A Chronic Condition Special Needs Plan (CSNP) is for people who have a chronic health condition.
- A Dual Eligible Special Needs Plans (DSNP) is for people who have both Medicare and Medicaid.
Special Needs Plans are Medicare Advantage (also called Medicare Part C) plans designed by private insurance carriers for people who meet the eligibility requirements:
- A Chronic Condition Special Needs Plan (CSNP) is for people who have a chronic health condition.
- A Dual Eligible Special Needs Plans (DSNP) is for people who have both Medicare and Medicaid.
These two types of plans share some benefits but are targeted to meet the needs of specific groups of people on Medicare, the health insurance program for U.S. adults who are over 65 years old or live with certain disabilities. We’ll examine some of these plans’ key features, benefits, and eligibility requirements.
CSNP vs. DSNP at a Glance
| C-SNP | D-SNP | |
| Name | Chronic Condition Special Needs Plan | Dual Eligible Special Needs Plan |
| Who it’s for | Those with a qualifying chronic condition | Those eligible for both Medicare and Medicaid |
| Part A | Included | Included |
| Part B | Included | Included |
| Part D | Included | Included |
| Medicaid coordination | No | Yes |
| Condition care management | Yes | No |
Overview of Chronic Condition Special Needs Plans (CSNP)
Like other Medicare Advantage plans, CSNPs are offered by private insurance carriers to substitute for Original Medicare (Parts A and B) from the federal government. They must at least match the coverage you’d get from Original Medicare and may include additional benefits.
However, CSNPs stand apart from most Medicare Advantage plans because they are designed for people with a specific chronic condition. These plans typically provide more coverage for relevant specialists, treatments, and medications. To get the most out of your coverage, CSNPs generally require you to visit healthcare providers and pharmacies that are in a provider network.
Plan availability varies based on your county. A licensed insurance agent can help you check if there’s an appropriate plan available to you.
CSNP Eligibility
To be eligible for CSNP, you must already be enrolled in Medicare Parts A and B. The Centers for Medicare and Medicaid Services (CMS), the federal agency that administers Medicare, have approved plans for the following conditions:
- Cardiovascular disorders like cardiac arrhythmias and coronary artery disease
- Chronic heart failure
- Diabetes
- Lung disorders like asthma, chronic bronchitis, and emphysema
- End-stage renal disease (ESRD) requiring dialysis
- Chronic dependence on alcohol or other drugs
- Autoimmune disorders like rheumatoid arthritis and lupus
- Cancer
- Dementia
- End-stage liver disease
- Severe hematologic disorders like hemophilia and sickle-cell disease
- HIV/AIDS
- Chronic and disabling mental health conditions like bipolar disorders, major depressive disorders, or schizophrenia.
- Neurologic disorders like amyotrophic lateral sclerosis (ALS), epilepsy, extensive paralysis, multiple sclerosis, Parkinson’s disease, or Huntington’s disease
- Stroke
Plans may cover just one of these conditions or group together similar ones. You are only eligible to enroll in CSNPs that insurance carriers offer in your area, so check whether there’s a plan that’s right for you.
CSNP Coverage
Some benefits are included with all CSNP plans, like:
- Hospital and medical coverage
- Care coordination
- Medicare Part D prescription drug coverage
Plans may include a variety of additional benefits that are specific to the covered condition and the needs of members. Some possible examples include:
- Care and services from specialists
- Extra time in the hospital beyond what’s covered by Part A
- Supplies, such as for monitoring and measuring blood sugar
- Preventive care
- Vision
- Hearing
- Dental
- Foot care
- Credit for food and over-the-counter items
You can learn what benefits may be available to you by exploring plans that are focused on your condition and offered in your ZIP code.
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Overview of Dual Eligible Special Needs Plans (DSNP)
DSNPs are available to people who are eligible for both Medicare and Medicaid, the public health insurance program for U.S. adults with limited incomes and financial resources.These plans coordinate health coverage between the two programs and may offer other benefits as well.
- Medicare is a federal program, so Original Medicare coverage (Parts A and B) is the same for Medicare beneficiaries all over the United States.
- Medicaid is a joint federal and state program, so your coverage could be different from what’s offered in other states.
- Different Medicare Advantage plans – which include DSNPs – are available in every ZIP code.
DSNP Eligibility
DSNP eligibility is relatively simple. You are eligible for a DSNP plan if:
- You have Medicare Parts A and B
- You are eligible for Medicaid in your state. This includes all categories of Medicaid coverage, listed below.
- Full Medicaid
- Qualified Medicare Beneficiary (QMB)
- QMB Plus
- Specified Low-Income Medicare Beneficiary (SLMB)
- SLMB Plus
- Qualifying Individual (QI)
- Qualified Disabled and Working Individual (QDWI)
DSNP availability depends on the area where you live. However, according to an analysis from 2022, 92% of DSNP eligible people had access to at least one plan.
DSNP Coverage
Like CSNPs, all DSNPs include:
- Hospital and medical coverage
- Care coordination
- Medicare Part D prescription drug coverage
Additional benefits vary based on your Medicaid coverage and the specific DSNP plans in your area, but may include:
- Vision
- Dental
- Fitness
- Hearing
- Credit for food and over-the-counter items
- Transportation
Having Medicaid coverage as well as Medicare often reduces costs such as premiums, copays, and coinsurance.
How to Choose Between CSNP and DSNP When You’re Eligible For Both
What should you do if you have a chronic condition and Medicaid, making you eligible for both CSNPs and DSNPs? You can’t be enrolled in both types of plans at the same time, so consider these factors:
- Costs: The price tag is often a major factor in our healthcare decisions. When choosing a plan, look beyond the monthly premiums: If you choose DSNP, will the costs for your specialized services (e.g. specialists, treatments, and medication) be higher than what you’re saving on premiums or copays? Do the CSNPs available in your county cover benefits that would make a difference in your life? Would the savings from DSNP pay for those services? Keep in mind that you can still enroll in Medicaid without a DSNP, though coordinating your coverage might be more complicated.
- Availability: Since the availability of CSNP and DSNP plans varies by location, explore the options in your area. More choices might mean you can shop around for the lowest costs and most useful benefits. You should also check the plans’ provider networks to see if your preferred doctors are included.
- Eligibility: While none of us can see the future, you can also consider your future eligibility. Do you expect to lose your eligibility for either a CSNP or DSNP within the next plan year? If so, you might choose the other type of plan so you don’t need to change mid-year.
Enrolling In a Special Needs Plan
Whether you choose CSNP or DSNP, enrollment follows a similar process. You can join a plan online or over the phone, either working directly with the insurance carrier or with a licensed insurance agent who represents multiple carriers. During that process, you may need information like your address, phone number, email, Medicare number, doctors’ names, and prescriptions.
Enrollment for Medicare plans isn’t open at all times. There are three main enrollment periods when you might be able to enroll in a Special Needs Plan:
- Initial Enrollment Period: The Initial Enrollment Period occurs when you first become eligible for Medicare. For most U.S. adults, the period starts three months before the month of their 65th birthday and concludes three months after their afterward. During this time, new enrollees in Medicare Parts A and B can choose to switch to a Medicare Advantage plan, including SNPs.
- Annual Enrollment Period: The Annual Enrollment Period occurs every year from October 15 through December 7. This enrollment period applies to all Medicare beneficiaries and provides the opportunity to change plans for the coming year.
- Special Enrollment Period: Special Enrollment Periods occur when circumstances affect your Medicare eligibility, change the type of plan you need, or interfere with other enrollment opportunities. Becoming eligible for Medicaid or being diagnosed with a condition covered by CSNP will generally open a Special Enrollment Period.
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Putting It All Together
CSNP and DSNP are similar kinds of Medicare Advantage plans for individuals with specific healthcare needs. For people with chronic conditions, CSNP provides more coverage for relevant services. For people who are eligible for both Medicare and Medicaid, DSNP provides bundled coverage that coordinates the two programs.
You could be eligible for both these types of SNPs, but you can only choose one. Compare your options to make sure you’re on the ideal plan for your needs.