D-SNP Drill Down: Why You Should Focus on this Growing Market - Western Asset Protection
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D-SNP Drill Down: Why You Should Focus on this Growing Market

Special Needs Plans (SNPs) are on the rise, and D-SNPs in particular are becoming much more common. When you become knowledgeable about Special Needs Plans, you position yourself to serve more clients and to bolster your post-AEP income.

There are three types of SNPs: I-SNPs serve Medicare enrollees who need institutional care, C-SNPs serve Medicare enrollees with chronic conditions, and D-SNPs serves Medicare enrollees who are also eligible for Medicaid. According to KFF, Medicare beneficiaries will have access to more than 850 SNPs in 2020, and the number of D-SNPs has increased 58 percent since 2016.

Medicaid, Medicare and D-SNPs

Medicaid and Medicare sound similar enough that some people get them confused, but the two programs are very different. While Medicare is a federal insurance program for seniors and some younger people with disabilities, Medicaid is a federal and state program that serves people with limited resources.

Despite these major differences, there is some overlap. Many people qualify for both Medicare and Medicaid. Dual Eligible Special Needs Plans, or D-SNPs, cater to this group.

SNPs, including D-SNPs, are Medicare Advantage pans. All SNPs include prescription drug coverage, and additional benefits may also be provided.

Dual Eligibility Stats

According to Medicaid, there are 12 billion dually eligible enrollees, including 7.2 million seniors and 48 million people with disabilities.

Medicare enrollees who are eligible for Medicaid can get help paying for premiums and out-of-pocket expenses.  Qualification for Medicaid varies from state to state but is based on income and resources. In Arizona, the income limit for seniors as of February 1, 2019, is $1,041 per month for the applicant or $1,410 per month for the applicant and spouse. In order to apply, applicants must also apply for any other income that may be available, such as Social Security retirement benefits or pensions.

Within Arizona, several D-SNPs cater to different counties. According to the Arizona Health Care Cost Containment System (AHCCCS), which runs Medicaid in the state, “Requiring each ACC Medicaid health plan to offer a partner Medicare D-SNP promotes the enrollment or alignment of dual eligible members in the same health plan for both Medicare and Medicaid services to the greatest possible extent.”

Helping Dually Eligible Clients

Insurance coverage can be complicated and navigating both Medicaid and Medicare at the same time can be especially challenging. D-SNPs simplify coverage issues for dually eligible beneficiaries by coordinated services under a single plan. D-SNPs can be a great option for those who qualify.

When Medicare beneficiaries qualify for Medicaid, they do not have to wait until the next regular enrollment period to switch to a D-SNP. Dually eligible beneficiaries are entitled to Special Enrollment Period. This makes D-SNPs a great benefit for agents to focus on once AEP is over.

Want to learn more?

I encourage all Medicare agents to engage with your local D-SNP carriers. Many carriers are offering webinars and training now. Take advantage of the resources available to you!