If a person is QI, do they have to get a regular MAPD?

[Special Agent]

That Aetna plan is great for someone who is partial, I probably wouldn't put them in the UHC plan as it has much higher copays ($1,780 for a hospital stay!)

Aetna definitely friendlier to partials as far as cost but in my area they use a far inferior provider network compared to their PPO .I imagine this cost share spend down for partials will change bigly for 2025

 

[Special Agent]

That Aetna plan is great for someone who is partial, I probably wouldn't put them in the UHC plan as it has much higher copays ($1,780 for a hospital stay!)

because of the provider network i have put partials who wanted the 270.00 food card on UHC DSNP who had only medicare explaining to them that as far as cost it is basically the same as having only medicare ( actually a little better because of moop , flat copay for ER,0 drug copay ) I believe many times the doctors don't even try to collect the 20% but usually will collect the 240 deductible but i make it clear that they should expect to pay these cost.

 

[Penelope H]

The monthly SEP applies only to FULL Duals:

Upcoming Changes for Dually Enrolled Individuals: The Final 2025 Medicare Advantage Rule - Justice in Aging

In April 2024, the Centers for Medicare and Medicaid Services (CMS) issued a final rule for 2025 Medicare Advantage Plans and Prescription Drug Plans (“Part

justiceinaging.org

Enrollment Restrictions Compared to Current SEP Policy

While the new SEPs simplify enrollment choices and advance goals of integration, the changes also act to limit enrollment and disenrollment options compared to before the Final Rule as follows:

• Individuals with LIS, but who are not also enrolled in Medicaid, will no longer be allowed to switch Medicare Advantage plans on a quarterly basis. They must wait until Open Enrollment, an initial enrollment period, or meet the requirements for one of the other SEP options available.[13]
• Partial-benefit dually eligible individuals will no longer be allowed to switch between Medicare Advantage plans on a quarterly basis. They must wait until Open Enrollment, an initial enrollment period, or meet the requirements for one of the other Medicare Advantage SEP options available.
• Full-benefit dually eligible individuals will no longer be allowed to switch Medicare Advantage plans on a quarterly basis when their choice of plan is not integrated and aligned. They must wait until Open Enrollment, the Medicare Advantage Open Enrollment period, an initial enrollment period, or meet the requirements for one of the other Medicare Advantage SEP options available to enroll into an un-integrated and aligned plan.
• Some states restrict when a person can change Medicaid managed care plans. Combined with the Final Rule that requires Medicaid managed care alignment to enroll into an integrated D-SNP, individuals may have limited opportunities to change plans.

 

[MedicareWAA]

I thought it was only integrated dsnps that could change monthly but I was wrong . I've read at least 10 articles that all dsnp and lis can move plans monthly in 25

This is not true. Only the HIDEs and FIDEs get monthly SEPs next year. Not sure where you're reading your news.

 

[DonP]

This is not true. Only the HIDEs and FIDEs get monthly SEPs next year. Not sure where you're reading your news.

If you look at my response that was 4 months ago when there was confusion about it