Opinions on what is expected with the final rule for Medicare

[kgmom219]

What the heck are you guys talking about??

Duals can move monthly as of 1/1/25.

Are you separating duals from LIS? (This is way outside my box, but I’m 100% on duals going monthly as of 1/1/25. And I’m only on page 400-ish, so don’t ask me for a page number until May 1)

 

[DonP]

Read very carefully from the new cms rules “ by reducing the # of dual eligible plans that can move outside the annual enrollment period it will cut down on the aggressive marketing that occurs yr round “‘. It seems you can move monthly into a pdp or INTEGRATED dsnp . Cms wants mass migration of dsnps to integrated dsnps . 70% of dsnps are non integrated . I calculated there’s about 20 million dual or lis eligible Medicare beneficiaries . That’s about 30% of all people on medicare which is huge . Latest stats show 33 million on mapd and 13 plus million on med sups . Kingdom you seem to be much more into the workings of mapd that a yr or 2 ago . If your bringing loa’s on they’ll have to sell some mapds to survive . I’m curious you said you do a lot of aca . I’m assuming most of the people you write aca get some type of subsidy ?

 

[Chazm]

What the heck is an integrated DSNP?

 

[DonP]

What the heck is an integrated DSNP?

The mapd and medicaid are administered by the same carrier so coordination of benefits is seamless . 70% of all dsnp’s are not integrated . For instance in the state of Indiana for 2025 dsnp members are getting letters which of 3 big carriers they want as their Medicaid provider. If they choose a different one than their present dsnp in Jan they will be enrolled in their new dsnp to align with their new Medicaid . If they do nothing then there present dsnp carrier should align with there Medicaid with the same carrier

 

[kgmom219]

Read very carefully from the new cms rules “ by reducing the # of dual eligible plans that can move outside the annual enrollment period it will cut down on the aggressive marketing that occurs yr round “‘. It seems you can move monthly into a pdp or INTEGRATED dsnp . Cms wants mass migration of dsnps to integrated dsnps . 70% of dsnps are non integrated . I calculated there’s about 20 million dual or lis eligible Medicare beneficiaries . That’s about 30% of all people on medicare which is huge . Latest stats show 33 million on mapd and 13 plus million on med sups . Kingdom you seem to be much more into the workings of mapd that a yr or 2 ago . If your bringing loa’s on they’ll have to sell some mapds to survive . I’m curious you said you do a lot of aca . I’m assuming most of the people you write aca get some type of subsidy ?

1. What’s the difference between an integrated vs non integrated DNSP?
2. ACA subsidy vs Medicaid eligibility (especially in a non expansion state like TX) are apples to popsicles. I’ve got people with 1 million plus in the bank getting a subsidy.
3. My LOAs are getting paid the same amount for ACA, Med Supp or MAPD, so there is no bias.
4. I still hate MAPD. But for people who can’t move from MAPD to Med Supp, my ethics aren’t violated. And with the changes coming on MAPD for 2025, I think there will be a lot of opportunity and I’m going all in.

 

[DonP]

1. What’s the difference between an integrated vs non integrated DNSP?
2. ACA subsidy vs Medicaid eligibility (especially in a non expansion state like TX) are apples to popsicles. I’ve got people with 1 million plus in the bank getting a subsidy.
3. My LOAs are getting paid the same amount for ACA, Med Supp or MAPD, so there is no bias.
4. I still hate MAPD. But for people who can’t move from MAPD to Med Supp, my ethics aren’t violated. And with the changes coming on MAPD for 2025, I think there will be a lot of opportunity and I’m going all in.

I explained the difference in integrated dsnp above . Well you’ll be super busy come aep moving people getting pdp premiums doubled or more . Also med sup premiums up 10-20% . Your forgetting about the huge changes about to hit sup and pdp premiums .2025 aep is more about protecting your book than writing new . Just curious where are you getting all these leads for your Loa’s ? I assure you if it’s any type of non t-65 social media , direct mail etc it’s mostly lower income and mapd land .

 

[hockeyday]

The items below aren’t in order . These are the new rules on dsnps /lis If a persons moving from an integrated dsnp they can switch to another integrated dsnp or a pdp on a monthly basis . If there not on an integrated dsnp it’s the rules of regular mapd . Cms says “ to cut down on agressive marketing year round “ . So this should cut down big on flipping after oep . I’m sure if call centers start using bogus aeps complaints t Medicare will sky rocket and carriers will crack down big

Explained the integrated thing in simple terms for me please,

 

[hockeyday]

The mapd and medicaid are administered by the same carrier so coordination of benefits is seamless . 70% of all dsnp’s are not integrated . For instance in the state of Indiana for 2025 dsnp members are getting letters which of 3 big carriers they want as their Medicaid provider. If they choose a different one than their present dsnp in Jan they will be enrolled in their new dsnp to align with their new Medicaid . If they do nothing then there present dsnp carrier should align with there Medicaid with the same carrier

Who does the integrated thing? Humana uhc ..is this rule change all dsnp in all states in 2025

 

[DonP]

Explained the integrated thing in simple terms for me please,

Who does the integrated thing? Humana uhc ..is this rule change all dsnp in all states in 2025

No all states won’t have . Cms is pushing all states to get over next few yrs I believe . In layman terms a duals dsnp and Medicaid is administered by the same company in an integrated dsnp . Benefits are much smother . Inidiana is starting it in 2025 . I believe Fla already has . I don’t know what states have . In Indiana a mailer went out to dsnps to pick there Medicaid carrier between 3 . If they pick a Medicaid carrier different than there dsnp there dsnp will be moved to match up with the Medicaid carrier they picked . Also in Indiana someone in Medicaid that gets Medicare will be auto enrolled in a dsnp . So no more running into a layup . Honestly I think the agent will be removed from dsnps in 3-5 yrs

 

[hockeyday]

No all states won’t have . Cms is pushing all states to get over next few yrs I believe . In layman terms a duals dsnp and Medicaid is administered by the same company in an integrated dsnp . Benefits are much smother . Inidiana is starting it in 2025 . I believe Fla already has . I don’t know what states have . In Indiana a mailer went out to dsnps to pick there Medicaid carrier between 3 . If they pick a Medicaid carrier different than there dsnp there dsnp will be moved to match up with the Medicaid carrier they picked . Also in Indiana someone in Medicaid that gets Medicare will be auto enrolled in a dsnp . So no more running into a layup . Honestly I think the agent will be removed from dsnps in 3-5 yrs

I'll be retired in 3-5 years, so in 2025 all dsnp members can only switch plans like all mapd members