Understanding Redetermination and Dual Eligible Beneficiaries

Understanding  Redetermination and Dual Eligible Beneficiaries 

In the past four years, enrollment in Dual Eligible Special Needs Plans (D-SNPs) has doubled to more than five million individuals. The D-SNPs are meant to meet the needs of people who are eligible for both Medicare and Medicaid. 

D-SNPs are one of several plans within the Medicare Advantage program comprise the largest category both in enrollment and the number of plans offered. Due to the nature of D-SNPs, there are challenges for members, and their agents as well. 

The Journey for Medicaid and Medicare Members  

Dual-eligible members simultaneously enrolled in Medicaid and Medicare may be eligible due to low income, age, or disability. Within this framework, the primary payer for acute-care services is Medicare, with Medicaid providing other coverage. 

Based on the most recent state-reported data sourced from KFF.org, 69% of all people who were disenrolled had their Medicaid coverage terminated for procedural reasons, not necessarily because they were ineligible. 

For Medicaid members, the first time they learn they no longer have coverage could be when they receive a Medicaid Letter of Termination. A disenrollment can be triggered by a non-updated mailing address or missing a step in the renewal process. 

Guiding and Proactively Assisting Your Clients During Redetermination 

Become a Subject Matter Expert in the dual-enrollment and redetermination process. Creating a process to assist your clients in maintaining their coverage. Keep in touch with your insureds to verify they are meeting their timelines for redetermination. 

Provide them with a level of comfort knowing that you are invested in their well-being. Let them know that they do not have to lose their medical care or change plans if they provide the information requested within the allotted timeframes. 

Remind your clients that all Medicaid members renew their eligibility for Medicaid annually. Impress upon them how crucial it is to keep the Medicaid office updated with their most current contact information and mailing address. 

Then, equally important is responding within Medicaid’s guidelines to any requests that come from their office. If clients receive a Medicaid renewal form, they need to complete and return it by the deadline given to avoid a gap in coverage. 

Tips to Grow and Maintain Your D-SNP Clients 

  • Offer client assistance with forms or refer to a local agency that specializes in assisting those who have questions about their D-SNP 
  • Use all of your communication tools to remind your D-SNP clients of the timelines and news regarding their redetermination process. Outreach may include social media, websites, email, public speaking, and phone calls. 
  • Have necessary phone scripts that everyone can access to provide proper verbiage, steps, and details to assist phone customers 
  • Provide staff training on special enrollment periods, how to help clients, and addressing the potential to lose eligibility 
  • When training staff, coach the client-facing roles to verify with clients that they are formally receiving their personal Medicare plan information at their address (mailing and email) and that they are maintaining contact during their redetermination period. 
  • Train staff to assist clients with accessing the best documentation for Medicaid redetermination 
  • Provide a process to staff in regard to assisting clients who may lose eligibility and may need to be enrolled into another plan 
  • Create a digital file for all insurance news, plan letters, and policies related to D-SNP 

Recently, Molina Healthcare Broker Channel Manager Jonathan Roldan presented the webinar “Understanding Redetermination and Dual-Eligible Beneficiaries.” According to Roldan, the most important thing agents can do is to “make the client #1.” 

He said one of the biggest challenges of dual enrollment is that members can change plans quarterly. However, the benefit of selling D-SNP is that they typically provide more supplemental benefits than a traditional MAPD Plan. 

Private insurance companies, by law, are required to offer plans that have the original Medicare Part A, Part B and Part D. Many of the D-SNPs provide additional benefits such as preventative care services and wellness management programs. 


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