Clarification on DSNP plan switches for 2025

[DonP]

Full disclosure i don't sell DSNP in any state that dictates which DSNP plan peeps can enroll in and when they can enroll but for states with the typical rules like Florida it means that agents can only use the election code( SEP -Integrated Plan) for DSNP applications for Full Dual eligibles as long as the DSNP carrier you want to enroll them in has a managed medicaid contract in that state- it does NOT have to be the same managed medicaid plan they are currently enrolled in.In Florida for example this means in 2025 you can't enroll someone in a DSNP using (SEP-Integrated Plan) that doesn't have a MMA contract like AETNA DSNP and UHC DSNP ( unless they win the appeal about losing the MMMA contract in 2025)

Correct the Medicare/Medicaid carrier must match in being integrated . What we're saying is once the person is in an integrated plan like uhc they can only move during aep or oep that's it . The monthly dsnp aep is for ANYONE WHOS NOT ON A INTEGRATED plan to have a sep to move to one any time . So once your on an integrated plan as far as moving plans it's basically aep/sep just like a non integrated .

 

[Special Agent]

Correct the Medicare/Medicaid carrier must match in being integrated . What we're saying is once the person is in an integrated plan like uhc they can only move during aep or oep that's it . The monthly dsnp aep is for ANYONE WHOS NOT ON A INTEGRATED plan to have a sep to move to one any time . So once your on an integrated plan as far as moving plans it's basically aep/sep just like a non integrated .

Not exactly they can still switch past OEP but
1. they must have Full Medicaid-not qmb,slmb
2.the DSNP plan they want to switch to must have a MMA contract ( or whatever its called in a particular state)

 

[MedicareWAA]

Wait until the government drops the hammer on everyone fraudulently using disaster SEPs. I predict that's one of the next shoes to drop. No, thousands of people didn't actually miss a different valid enrollment period because of gun violence or border crossers or when President Carter's wife died.

I predict eventually the government will only let someone use that SEP if they do it with 1800-MEDICARE.

Walter