DSNP members cannot switch plans outside of AEP and OEP in 2025
- Thread starter Special Agent
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I don't think that's correct . Are you sure ? I thought it meant they could SWITCH monthly if you have integrated dsnp .. Regular non Integrated dsnps can only move during aep and oep
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- #23
Special Agent
Guru
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yes read it again the only thing i am not 100% clear on is what is considered a fully integrated DSNP but either way the rules about switching plans is the same ( different than just enrolling) In Florida for example DE on original medicare are assigned in to a MMA medicaid plan if they don't choose one.UHC is one of the these Medicaid MMA plans so does that mean that a DE on original Medicare with the UHC medicaid MMA plan in Florida considered enrolling in a fully integrated dsnp if they enroll in the UHC DSNP since UHC was already managing their Medicaid side?As opposed to someone who is DE with original medicare and UHC MMA medicaid but wants to enroll in Wellcare DSNP.
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- #24
Special Agent
Guru
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that's the upside to some agents but the downside is if the call center churn one of our clients before OEP ends where screwed.
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One of the carrier directors informed us that the "integrated" DSNPs are the FBDEs or what we call MQMB Star Plus in Texas who will get the 1/mo switch (a minute percentage of my book).
The much more common regular QMBs/SLMBs/QI-1s would have the AEP and OEP to make switch plus the various FEMA SEPs that we could use outside of those periods.
The fact that we might still have the FEMA SEPs would still create opportunities for the call centers. I'm concerned that we would no longer have a valid SEP to use if the FEMA is all used up. If SEP for DUAL/LIS is gone, what would an agent use to switch them back?
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- #26
Special Agent
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Well in Florida anyway there will probably be FEMA SEPs in 2025 [EXTERNAL LINK] - Unprecedented ocean temperatures make this hurricane season especially dangerous
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None of this shit matters tbh, carriers self-regulate and put 90% of apps through whether there is a valid SEP or not - I don't expect that to change next year.
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- #28
Special Agent
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just don't use election code SEP- maintaining medicaid/lis because that one is gone for sure.
What I said is correct . You can switch from fully integrated to fully integrated every month . So states with fully integrated will be monthly . Other states supposedly only aep and oep . As the other poster said CO's control the approval of seps and you can easily move people 3-4 times every yr . Call centers use paper and move . Carriers don't ask for proof you moved
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- #30
Special Agent
Guru
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It says if on original medicare they can enroll which different than switching like plans obviously.This may be a typo but that's how it reads.I do have more clarity on what highly integrated dsnp is .In Florida for example in 2024 uhc,wellcare,humana have a state medicaid MMA contract ( however one of these companies as of right now did not win the bid for MMA contract in Florida and maybe other states for 2025) so all their DSNP are considered highly integrated dsnp and you don't for example have to be on Humanas MMA medicaid to enroll in Humana SNP.Aetna and Devoted don't have a MMA contract so they will not have the SEP- integrated plan sep for their snp plan in 2025.BTW Devoted just announced today they are not renewing a major hospital system contract in Florida the UF Shands so they may be seeing the writing on the wall for their SNP Plans
