Tiffany Stiller

Many brokers tend to shy away from selling dual-special needs plans (D-SNPs) due to the perceived complexities associated with these plans. However, once you understand the basics, you will be well-positioned to introduce the topic and advise your clients.

By taking the initiative to educate your clients about D-SNPs, you can demystify the perceived complexities and highlight the benefits they offer. Start by explaining the fundamental concept of D-SNPs: These plans are specifically designed to cater to individuals who qualify for both Medicare and Medicaid. They provide comprehensive coverage that combines the benefits of both programs, offering a holistic approach to healthcare for eligible individuals.

To further ease any concerns your clients may have, you can break down the workings of D-SNPs into simpler terms. Emphasize that D-SNPs operate like other Medicare Advantage plans, providing coverage for medical services, prescription drugs, and additional benefits such as
dental and vision care. However, unlike traditional Medicare Advantage plans, D-SNPs are uniquely tailored to meet the specific needs of individuals who are dually eligible for Medicare and Medicaid.

What does it mean to be dually eligible?
Dual eligibility is a fancy term for saying an individual can have Medicare and Medicaid at the same time. D-SNPs are a type of Medicare Advantage plan (also known as Part C) that offers broader coverage to a specific population. These private plans help coordinate care between Medicare, a federal program, and Medicaid, controlled by the states. Nearly 12 million Americans are enrolled in both Medicare and Medicaid according to the Kaiser Family Foundation.

To be considered for a D-SNP individuals must first be enrolled in Medicare Part A, which covers hospitalizations, and/or Medicare Part B, which covers other medical services. Individuals are also enrolled in either full-benefit Medicaid or the Medicare Savings Program. These programs, controlled by each state, help beneficiaries with some, or all, of their Medicare Parts A and B expenses. These individuals are “dually eligible,” meaning they receive their primary health insurance coverage through Medicare benefits and get some assistance from their state Medicaid programs.

Dual eligible programs are typically offered to people with low income, who have specific medical conditions or have unique health care requirements.

What plan is your client eligible for?
As a broker, your clients are looking to you to help them understand their options, particularly if they are eligible for D-SNPs. There are five categories of D-SNPs. Which plan a client can enroll in depends on the Medicaid category they fall under.

• All-Dual Dual Special Needs: Any dual eligible beneficiary.
• Full-Benefit Dual Special Needs: Dual-eligible individuals who qualify for full Medicaid benefits for the month under any eligibility category, or medical assistance for any month if the individual was eligible for assistance in any part of the month.
• Medicare Zero Cost Sharing: Dual-eligibles who are not responsible for cost sharing for Medicare Parts A or B. Cost sharing is the “out-of-pocket” payments individuals make for medical services that insurance does not cover, such as deductibles, copayments and coinsurances.
• Dual Eligible Subset: This subset is determined by a Medicare Advantage organization in coordination with the state Medicaid agency. The Centers for Medicare and Medicaid Services reviews and approves requests for coverage of dual eligible subsets on a case-by-case basis. For states that use these plans, the D-SNP is charged first for medical services, then Medicaid picks up the cost share, covering some out-of-pocket costs and benefits.
• Dual Eligible Subset Medicare Zero Cost Sharing: Similar to the plan above, but does not include cost sharing.

Navigating the complexities of D-SNPs requires a comprehensive understanding of the program’s nuances, eligibility criteria and benefits. If you are unsure about the important details of D-SNPs, it is crucial to work with a trusted agency partner that can provide you with additional guidance and support. Collaborating with an experienced general agency allows you to provide your clients with accurate and up-to-date information and ensures you can offer your clients the best possible solutions tailored to their specific requirements.

What is Medicaid Redetermination?
Medicaid enrollment has skyrocketed since the start of the pandemic, likely due to the continuous enrollment provision. The provision was part of the COVID-19 Public Health Emergency (PHE) and prevented states from disenrolling people from Medicaid during the pandemic. In return, the states received enhanced federal funding.

Since the PHE ended in May 2023, many states have begun Medicaid redetermination, meaning they are looking over subscribers to determine if they are no longer eligible for benefits. Over the next 12 to 14 months, up to 24 million individuals that no longer meet state Medicaid criteria will be removed. As states review their Medicaid eligibility criteria, you may come across a situation where D-SNPs serve as an excellent solution to assist your clients affected by the Medicaid evaluation process. This presents a valuable opportunity to advise clients to discuss Medicaid redetermination with their employees. It is important to prioritize the well-being of employees who no longer qualify for Medicaid because they now meet the requirements for employer-sponsored healthcare. To ensure their best interest, it is strongly recommended to assist them in signing up for a plan during the open enrollment period.

Many brokers tend to shy away from selling dual-special needs plans (D-SNPs) due to the perceived complexities associated with these plans. However, once you understand the basics, you will be well-positioned to introduce the topic and advise your clients.

By taking the initiative to educate your clients about D-SNPs, you can demystify the perceived complexities and highlight the benefits they offer. Start by explaining the fundamental concept of D-SNPs: These plans are specifically designed to cater to individuals who qualify for both Medicare and Medicaid. They provide comprehensive coverage that combines the benefits of both programs, offering a holistic approach to healthcare for eligible individuals.

To further ease any concerns your clients may have, you can break down the workings of D-SNPs into simpler terms. Emphasize that D-SNPs operate like other Medicare Advantage plans, providing coverage for medical services, prescription drugs, and additional benefits such as
dental and vision care. However, unlike traditional Medicare Advantage plans, D-SNPs are uniquely tailored to meet the specific needs of individuals who are dually eligible for Medicare and Medicaid.

What does it mean to be dually eligible?
Dual eligibility is a fancy term for saying an individual can have Medicare and Medicaid at the same time. D-SNPs are a type of Medicare Advantage plan (also known as Part C) that offers broader coverage to a specific population. These private plans help coordinate care between Medicare, a federal program, and Medicaid, controlled by the states. Nearly 12 million Americans are enrolled in both Medicare and Medicaid according to the Kaiser Family Foundation.

To be considered for a D-SNP individuals must first be enrolled in Medicare Part A, which covers hospitalizations, and/or Medicare Part B, which covers other medical services. Individuals are also enrolled in either full-benefit Medicaid or the Medicare Savings Program. These programs, controlled by each state, help beneficiaries with some, or all, of their Medicare Parts A and B expenses. These individuals are “dually eligible,” meaning they receive their primary health insurance coverage through Medicare benefits and get some assistance from their state Medicaid programs.

Dual eligible programs are typically offered to people with low income, who have specific medical conditions or have unique health care requirements.

What plan is your client eligible for?
As a broker, your clients are looking to you to help them understand their options, particularly if they are eligible for D-SNPs. There are five categories of D-SNPs. Which plan a client can enroll in depends on the Medicaid category they fall under.

• All-Dual Dual Special Needs: Any dual eligible beneficiary.
• Full-Benefit Dual Special Needs: Dual-eligible individuals who qualify for full Medicaid benefits for the month under any eligibility category, or medical assistance for any month if the individual was eligible for assistance in any part of the month.
• Medicare Zero Cost Sharing: Dual-eligibles who are not responsible for cost sharing for Medicare Parts A or B. Cost sharing is the “out-of-pocket” payments individuals make for medical services that insurance does not cover, such as deductibles, copayments and coinsurances.
• Dual Eligible Subset: This subset is determined by a Medicare Advantage organization in coordination with the state Medicaid agency. The Centers for Medicare and Medicaid Services reviews and approves requests for coverage of dual eligible subsets on a case-by-case basis. For states that use these plans, the D-SNP is charged first for medical services, then Medicaid picks up the cost share, covering some out-of-pocket costs and benefits.
• Dual Eligible Subset Medicare Zero Cost Sharing: Similar to the plan above, but does not include cost sharing.

Navigating the complexities of D-SNPs requires a comprehensive understanding of the program’s nuances, eligibility criteria and benefits. If you are unsure about the important details of D-SNPs, it is crucial to work with a trusted agency partner that can provide you with additional guidance and support. Collaborating with an experienced general agency allows you to provide your clients with accurate and up-to-date information and ensures you can offer your clients the best possible solutions tailored to their specific requirements.

What is Medicaid Redetermination?
Medicaid enrollment has skyrocketed since the start of the pandemic, likely due to the continuous enrollment provision. The provision was part of the COVID-19 Public Health Emergency (PHE) and prevented states from disenrolling people from Medicaid during the pandemic. In return, the states received enhanced federal funding.

Since the PHE ended in May 2023, many states have begun Medicaid redetermination, meaning they are looking over subscribers to determine if they are no longer eligible for benefits. Over the next 12 to 14 months, up to 24 million individuals that no longer meet state Medicaid criteria will be removed. As states review their Medicaid eligibility criteria, you may come across a situation where D-SNPs serve as an excellent solution to assist your clients affected by the Medicaid evaluation process. This presents a valuable opportunity to advise clients to discuss Medicaid redetermination with their employees. It is important to prioritize the well-being of employees who no longer qualify for Medicaid because they now meet the requirements for employer-sponsored healthcare. To ensure their best interest, it is strongly recommended to assist them in signing up for a plan during the open enrollment period.

We’re all familiar with the traditional standard ancillary benefits offering — dental, vision and life insurance plans. Ancillary benefits are offered through group insurance, either paid 100 per cent by the employee or shared contribution with the employee and employer. These are still valued benefits, but today’s employee is looking for more in their benefits package.

This is where voluntary/worksite benefits come into play. Voluntary benefits, or employee-paid benefits, are offered by an employer to their employees as a solution to meet the employee’s unique needs and fill potential gaps in their benefits coverage.

In recent years we’ve seen a slight shift from traditional ancillary benefits to the inclusion of voluntary benefits. Employers are still offering dental, vision and life insurance, but are also opting to provide more choice offerings when it comes to benefits. Since the offerings, local dentistry Dentist Sarasota, has seen an increase in check-ups from local residents.

Voluntary benefits tend to fall into four categories: Health, Wealth, Security, and Personal.

Health
1. Accident
2. Critical Illness
3. Hospital Indemnity

Wealth
1. Disability
2. Legal
3. Financial Counseling

Security
1. Travel Accident Insurance
2. Identity Theft Protection

Personal
1. Discount on car insurance, homeowners, or pet insurance
2. Concierge services
3. Umbrella insurance

Offering voluntary benefits has several positive outcomes for employers which include little or no cost to the employer, an alternate way to control rising healthcare costs and the ability to attract and retain top talent. Voluntary benefits are a great way for companies to stand out and capture the best candidates in the workforce as well as enrich the traditional benefits offering. These benefits assist in targeting the needs of different generations who have differing priorities as they move through the stages of life.

Year after year the market has seen an increase in the demand for voluntary benefits. Research shows that voluntary benefit sales have grown every year since 2004. According to Metlife’s 9th Annual study of Employee Benefits Trends, published in 2011, 60 percent of employees say employee benefits offered are an important reason to remain with an employer and 52 percent are interested in having their employers provide a wider range of voluntary benefits.

Why do employees continually request these benefits?
1. Low-cost coverage
2. Pre-taxed premiums
3. Payroll deducted
4. Quick claims turnaround

Voluntary benefits are a cost-effective solution to help offset the out-of-pocket medical expenses and fill the gaps created by high deductibles and rising copays. Often, voluntary benefits packages reduce redundant costs by ensuring employees can personalize their benefits package. Instead of offering all employees a benefit that they don’t need, they can now tailor a combination of products to their specific needs. This ability to customize a benefits package results in increased group penetration.

Delivering these voluntary benefits has never been easier. Companies who specialize in benefits administration (BenAdmin), are leading the way in benefits transformation. BenAdmin products enable employers to offer a wide range of products coupled with a seamless enrollment process.

Brokers who are not offering voluntary benefits are at risk of not only losing revenue but also losing the customer to others who promote these offerings. The healthcare industry is a competitive space and brokers who stick with strictly medical benefits are probably feeling some competitive pressure. Competition among brokers will continue to grow every year as voluntary benefits grow in number and demand. Brokers who diversify their product offering are more attractive to potential clients. Offering voluntary benefits is a great way for brokers to supplement revenue in an era of compressed medical commissions.

So how can a broker get started on offering voluntary benefits?
The first step is to fully understand the vast range of products. This knowledge can be sought from carrier partners, fellow brokers, broker associations (such as NAHU), and general agency partners.

The next step is to find a trusted BenAdmin system. The benefits technology revolution that has come about in recent years has contributed to brokers being able to grow and maintain their book of business while also supporting their client’s needs. BenAdmin partners streamline processes and help connect carriers, brokers and employers. For employers, benefits enrollment and benefits administration is a top priority. Online enrollment tools make benefits selection easy for employees by using side-by-side plan comparisons, decision making tools, e-signatures, and real-time updates. Employers can use online tools to manage benefits and employee profiles, new hire and open enrollment capabilities, contribution amount management, in-depth reporting tools, flexible portal design and customizable interface, content management tools, and voluntary benefits such as dental, vision, legal assistance and veterinary discounts. The end-goal for employers is to find a solution to streamline the integration of all benefit offerings and administration.

As companies look for ways to attract and retain top talent, brokers need to provide solutions to enhance their clients’ total compensation packages. Brokers should be ready to offer a robust portfolio of voluntary benefits.

Win-Win for All—Brokers, Employers and Employees
Brokers benefit from supplemental benefits by increasing sales, commissions and satisfaction, offering their clients a no-cost way to expand their benefits offerings. Employers benefit by offering employees an attractive and diverse suite of benefits at no added cost to the employer. Employees benefit with the ability to shop and buy products from leading companies to enhance their coverage and meet their personal coverage needs.