In 2026 i read on the cms site ppo dsnps Will no longer cover full out of network reimbursements . You ain't seen nothing yet as hospitals and carriers go to war . It's going to be a cluster f as members in the middle . In June along I got to move 9 people who lost Medicaid . I've made a shitload of money with duals over the yrs but I'm reevaluating if I want to really write many during aep and beyond . Handwritings on the wall . I'll be very interested how many plans carriers have in 2025 from the past yrs are non commission able . The days of sucking renewals on the same plan yr in yr out are over . I'll be shocked if I don't have to move 1/2 my book aep . It's going to be a catastrophe
DSNP members cannot switch plans outside of AEP and OEP in 2025
- Thread starter Special Agent
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This quarterly rule seems to only be mentioning dually eligible members (partial or full) but does not specifically mention LIS members. Granted, duals automatically are given LIS, but someone can be LIS and not be a dual.
As it stands it appears any LIS member cannot make a quarterly change, but they do not mention this.
Am I interpreting this wrong?
As it stands it appears any LIS member cannot make a quarterly change, but they do not mention this.
Am I interpreting this wrong?
Your correct. This includes lis. What's happening is non integrated plans are switching all the time and the Medicare/ Medicaid can't get on the same page for coordination of benefits
So when and how do I figure out if the carriers in Michigan are fully integrated
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- #35
Special Agent
Guru
- 621
If you sell a DSNP that also has a contract for the medicaid side for people on original medicare than it is either a FIDE or HIDE plan
The SEP for dual-eligibles and those with LIS is changing -- no more quarterly limitation. It's available monthly all year, but can only be used for PDP enrollment.
The new SEP is for "aligned enrollment" where the carrier provides Medicaid and DSNP coverage. The allowed DSNPs are full-integrated, highly-integrated, and applicable integrated. Plans will likely make it clear which DSNPs they have are which.
The SEP for dual-eligibles and those with LIS who have a loss/gain/change in their level of Medicaid/Extra Help will still be available.
And I'll throw in my reminder that the Disaster SEP is meant to be used when another election is missed. It's not to fraudulently enroll someone when they have no other election available.
The new SEP is for "aligned enrollment" where the carrier provides Medicaid and DSNP coverage. The allowed DSNPs are full-integrated, highly-integrated, and applicable integrated. Plans will likely make it clear which DSNPs they have are which.
The SEP for dual-eligibles and those with LIS who have a loss/gain/change in their level of Medicaid/Extra Help will still be available.
And I'll throw in my reminder that the Disaster SEP is meant to be used when another election is missed. It's not to fraudulently enroll someone when they have no other election available.
What is fide or hide?, that pdf is for people under 65 not on Medicare, but have expanded Medicaid called healthy Michigan, so your saying a full Medicare/full Medicaid 70 year old person is going to be automatically put on one of those plans?
- Thread starter
- #39
Special Agent
Guru
- 621
if the state has a contract with any managed medicaid plan for people on medicare ( which most states do) and that insurance company also offers a DSNP then their DSNP is either a FIDE or HIDE plan.HIDE are much more common than FIDE .Most of the big carriers have medicaid contract for people on original medicare.One big exception in Florida is Aetna
Medicare Advantage dual eligible special needs plans
Dual eligible special needs plans (D-SNPs) are a type of Medicare Advantage plan designed to meet the specific needs of dually eligible beneficiaries. Originally authorized as part of the Medicare…
www.macpac.gov
- Thread starter
- #40
Special Agent
Guru
- 621
"outside of those election periods( AEP,OEP),dual eligible consumers enrolled in original medicare may enroll in a PDP on a monthly basis.In addition,they may make a monthly election into a HIDE or FIDE or applicable Integrated plan AIP.Electing a non FIDE,HIDE or AIP DSNP using SEP Integrated Care is not permitted."
This is almost word for word what it says on UHC training slide so either this is a typo or DSNP cant switch after after OEP- they can only enroll if they are coming from original medicare.I would paste the actual slide but don't want to get in trouble for unauthorized reproduction.
