Selling Dual Eligible Special Needs Plans or D-SNPs isn’t for everyone. The 12 million or so Americans who are simultaneously enrolled in Medicare and Medicaid experience higher rates of chronic illness on average. Many of these people need some form of long-term care. Most of them need a little extra patience and understanding. Selling D-SNPs to the largely underserved dual eligible population can require a little more effort than selling conventional Medicare Advantage plans, but it can be very rewarding. Either way, there is an opportunity to meet and help these people year-round.
Keep in mind, dual eligible clients are not required to enroll in a Special Needs Plan. They might be fine with the coverage offered in a Medicare Advantage Plan. Ultimately, educating people about their available options and weighing the benefits of an MAPD against a D-SNP, is the best approach. These clients have likely been contacted by agents unfamiliar with D-SNPs who tried to push them towards the non-SNP MAPD in the first place.
D-SNPs work much the same way non-SNP MAPDs do. They generally include things like $0 monthly premiums, care coordination, transportation benefits and gym memberships. That’s the Medicare aspect of dual-eligibility. Medicaid benefits determine what type of D-SNP a dual-eligible can enroll in. There are five types:
- All-Dual: available to any dual-eligible beneficiary.
- Full-Benefit: available to dual-eligible beneficiaries who qualify for full Medicaid benefits under any eligibility category.
- Medicare Zero Cost Sharing: available to dual-eligible beneficiaries with no cost-sharing for Medicare Parts A or B.
- Dual Eligible Subset: availability based on a carrier’s coordinated with a State Medicaid Agency.
- Dual Eligible Subset Medicare Zero Cost Sharing: available to those who aren’t cost-sharing with Medicare but also determined in conjunction with a carrier and a State Medicaid Agency.
Medicaid programs can differ from state to state. If you need assistance helping your clients figure out what type of Medicaid or Medicaid-related program they’re eligible for or enrolled in, you can search for a local office at benefits.gov. For a selection of our carrier partners offering Dual Eligible Special Needs plans, visit our Carriers page and select “Medicare Advantage.”
Keep in mind, as of 2019, dual eligible beneficiaries are able to enroll or disenroll from a Medicare plan or Part D plan once per quarter. If a change is made in the first three quarters of the year, the enrollment or disenrollment will be effective on the first day of the following month. Dual eligibles wishing to enroll or disenroll during the fourth quarter have to take advantage of the Annual Enrollment Period from October 15th to December 7th.
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