People with serious health issues who qualify for both Medicare and Medicaid ("Dual Eligibles") are getting enrolled in insurance plans that may not truly meet their needs.
These plans, known as D-SNPs and C-SNPs, were created with good intentions. But in the real world, many people are end up in them because because of confusion, pressure, or even aggressive sales tactics.
Lets take a closer look at what’s really going on, and why PACE may be the better choice for a lot of elders with complex needs -- where PACE is available (which is not everywhere).
D-SNP vs. C-SNP vs. PACE
D-SNP (Dual-Eligible Special Needs Plan):
- For people who have both Medicare and Medicaid.
- Offers extra benefits like dental and vision.
- You still go to outside doctors and clinics, usually through a network.
C-SNP (Chronic Condition Special Needs Plan):
- For people with a specific illness like diabetes, COPD, or heart disease.
- These plans are focused on managing that one condition.
- If the person has other health issues, coverage may not be as strong or helpful.
- Can be enrolled easily with a fax to a physician, who checks a box verifying a health condition
For example, one woman was moved into a C-SNP without consent. She had diabetes (which the plan supported), but she also had multiple other conditions - arthritis, memory issues, mobility concerns -- which the plan did NOT support. She’d already nearly reached her out-of-pocket max on her old plan. As the insurance executive tells it,
"Yesterday, I received a heartbreaking call from a client who had been moved to a CSNP without their approval. Yes, they have medical conditions that the CSNP will help with—but they also have many other health issues that will cause them to hit their max out-of-pocket....Now they’re stuck in a plan with an $8,000+ maximum out-of-pocket they can’t afford—and they can’t move back. I was almost in tears hearing her story."
PACE (Program of All-Inclusive Care for the Elderly):
- PACE is like insurance + the provider + the care site all in one.
- No list of "PACE benefits" applies to everyone -- every person's care plan is 100% customized
- A person can NOT be enrolled without consent, not sold "over the phone," usually requires an in-home or in-person assessment before enrollment.
- For people 55+ who qualify for nursing home care but want to stay home.
- Doctors, nurses, therapists, social workers, home care aides—all under one roof.
- Care happens at home and at the PACE center, including appointments with the center’s own doctors and nurses.
- Transportation, meals, medication, and supplies are all included.
Brokers & Consumers: Learn About PACE at Age-in-Place Health
What Changed in 2025, and Why It Matters Now
In 2024, the government updated the rules to protect people from being aggressively steered into D-SNPs. Cold-calling and certain marketing tactics were banned. That was the right move.
But instead of slowing down, the sales machine just shifted gears. Many big call centers moved their focus to C-SNPs—plans that still allowed commissions and could be sold over the phone.
This led to a sharp increase in C-SNP enrollments. This is not because more people suddenly developed heart failure or COPD. This is because these plans became the next available product to push.
The Numbers
- Nationwide, C-SNP enrollment jumped 68% through early 2025.
- In North Carolina, growth hit 374% in a single year.
- In Mecklenburg County alone (Charlotte), enrollment soared by over 440%. (source: Deft Research MA Growth Tracker)
That kind of growth doesn’t happen by accident. It’s the result of a system that rewards speed and volume.
Why PACE May Be the Better Option Than D-SNPs or C-SNPs
1. One Team, One Care Plan, One Place --- and Everything Covered
PACE means no more guessing who’s coordinating care. It’s all coordinated by one group, the care team (Interdisciplinary team). The doctor is located in the PACE center, working side-by-side with the nurse, social worker, and therapist who know the patient. Each person has one customized care plan.
2. No Surprise Bills
For people with both Medicare and full Medicaid, PACE costs nothing out of pocket. No copays. No deductibles. No “coinsurance” traps. No monthly OOPs. No annual or lifetime maximums.
3. Built for People with Multiple Health Issues
C-SNPs are narrow by design. If someone has 5 diagnoses == dementia, diabetes, arthritis, and mental health concerns - a single-condition plan won’t meet the full picture.
PACE is built for complexity. The more needs a person has, the more it shines.
4. Stay Safe at Home
Most people want to stay in their homes. PACE makes that possible. It includes:
- Help with meals, medications, and bathing
- Home visits from nurses and aides
- Rides to and from the PACE center
- Early intervention before problems become crises
5. Support for Family Caregivers
Family members don’t have to figure everything out alone. PACE gives them real support, guidance, and relief. It’s a team effort—finally.
A Note on Commissions and What’s Driving This
Some agents may still receive commissions for enrolling people into D-SNPs, but the rules have changed. CMS has cracked down on side payments and administrative fees that used to inflate payouts. As of 2025, the structure is more regulated and standardized.
And while many D-SNPs still pay commissions, Part D drug plans have started pulling back entirely. Some Part D plans no longer pay commissions for new enrollments. That puts more pressure on agents and brokers to sell what's left -- C-SNPs.
CMS and States Need to Expand PACE
PACE works. It helps people live longer, stay safer, and avoid unnecessary ER visits and hospital stays. It keeps families together. It gives people peace of mind.
But here’s the problem: PACE isn’t available in every state or every county. And in rural areas, PACE programs face extra challenges: long drive times, workforce shortages, and fewer community resources.
If we truly want to serve the people who need help the most, we need to expand PACE. That means funding, support, policy change, and outreach.
It’s time to grow PACE. Everywhere. For everyone.
Sources:
This article includes data released by Deft Research which has been providing market research services and insights for the senior and commercial health insurance markets for the last 20 years in an effort to help their clients drive better business decisions.
The story about the woman enrolling in C-SNP was shared by Dustin VanDuine of Rick Young Insurance.