Dual Eligible Special Needs Plans (DSNPs), a type of Medicare Advantage plan, that enrolls individuals who are entitled to both Medicare and medical assistance from a state plan under Medicaid. States cover some Medicare costs, depending on the state and the individual’s eligibility.

There are seven total enrollment guidelines to be aware of with Special Needs Plans.

Chronic Condition:

• The consumer has a severe or disabling chronic condition that an appropriate SNP plan is designed to serve, AND the consumer is not currently enrolled in a Chronic SNP plan serving that condition.
• Begins upon qualification of a disabling condition and ends when the consumer enrolls into a SNP plan.
• Election Code: SEP Special Need/Chronic.

Special Needs Status Change:

• Disenrolled from SNP due to loss of special needs status.
• Begins month of the effective date of disenrollment and ends three months after the date of involuntary disenrollment.
• Election Code: SEP, loss of SNP status.

Chronic SNP Non-Eligibility:

• The consumer enrolled in a Chronic SNP who is not verified for enrollment and is disenrolled two months after the effective date.
• Begins upon notification of non-eligibility and ends two months after notice is received.
• Election Code: SEP, loss of SNP status.

Dual and LIS Eligible (maintaining):

• Medicaid and/or LIS Eligible.
• One election per calendar quarter for the first nine months of the year.

Q1: Jan- March

Q2: April-June

Q3: July-September

• Election Code: SEP, Dual LIS Maintaining.

Loss, Gain, or Change in Dual/LIS Status:

• Became eligible for any type of dual or LIS, losing/lost eligibility of any type of assistance, and/or have a change in the level of assistance received.
• Allows an opportunity to make an election within three months of any gain, loss, or change in level.
• Election Code: SEP, Change in Dual/LIS Status.

Institutionalized:

• Moves in, resides in, or moves out of a Skilled Nursing Facility, Nursing Facility, Immediate Care Facility, Psychiatric Hospital, Rehabilitation Hospital, or Long-Term Care Hospital with an expecting stay of at least 90 days.
• Begins first day institutionalized and ends two months after discharge.
• Begins first day discharged and ends two months later.
• Election Code: OEPI.

The dual eligible market is unique. It is also vastly under-worked in regards to insurance marketing. Agents who are aware of this enormous opportunity and choose to develop a marketing strategy to leverage this customer base need a unique set of tools to do so.  Lets take a look at the market and then into some proven methods our agents have been successful in helping these clients with, all the while adding revenue to their business’.

To be successful in the dual eligible marketing as an agent you need to get out and get involved! Invest in your game plan like you would if you were to present your plan to a bank.

In general, members of the dual community tend to prefer to meet face to face. Many times, their phone lines disconnect and change. They usually rely on an influencer like family/friends.  A continued presence helps build you credibility as a competent professional and enables people to feel comfortable approaching you. Make sure to sell yourself to the center of influence with each location. Work with the local area managers for funding and help with introductions. Bring the QMB Medicaid applications with you when you meet them. Help them make the dental and doctor appointments at the insurance appointment. Then go to that dentist/doctor/pharmacist and let them know you helped them set up another appointment. Stay engaged with them the clients/potential clients, influencers, and carrier agency managers.

Statistically 60% of DSNP prospects seek guidance from influencers. But who are these influencers?

• Family & Friends
• Doctors, Nurses, Pharmacists and In-Home Care Providers
• Community Agency Workers and Volunteers, Transportation Coordinators
• Church Staff or Members
• Tax Preparers, POAs, and Disability Attorneys
• Dentists and Dental Staff
• Insurance Agents

And where can these influencers & clients be found? Where are good places that can contribute to self-generating leads?

• Food Pantries  | Soup Kitchens  |  Meals on Wheels  |  Health Fairs
• Dollar Store’s  |  Bus Stops  |  Banks  |  Flea Markets  |  Laundromats
• Energy/Utility Assistance  |  Pre-paid Phone Outlets  |  Check Cashing Service
• Low Income Housing  |  Subsidized Housing  |  Homeless Shelters
• Doctors that accept Medicaid | Pharmacy’s | Dentist office
• Welfare Counselors  |  Attorneys that help members enroll in Medicaid
• Faith-based Organizations  |  Senior Centers
• Silver Sneakers Gyms  |  YMCA  | Gyms With Senior Classes
• Mobile Home Communities  |  Transportation Companies
• Veterans Associations  |  Fraternal Organizations  |  Community Events
• National Guardianship Association (Caregivers)

If you need help getting started here are some online resources to start you out in the community with your networking efforts.

Find low income housing areas   |   Find food pantry locations

Now you have the ideal client (and influencer) in mind, an idea about where to market and know how to find those places. What now? How do you get in front of those people? How do you get them to trust you as an advisor? How do you keep your brand and name in the forefront of their mind?

Here are some ideas to get you going. Tip: Think about location. Is it near a bus route? Easy to access for low-income beneficiaries? 

• Lunch and Learn Seminar or Educational Event
• Booths at Location or Community Events
• Bring in a Coffee Truck
• Ice Cream Social in the Summer
• Host an OTC Catalog Ordering Party
• Volunteer for the Food Bank or at the Senior Center
• Events/Handouts like: hats/gloves/socks, toothbrushes, soap for laundromat
• Hold a Free Family Photo Day
• Senior day at a retail location
• Hold a Caregiver Appreciation Luncheon
• Planting flowers in the spring
• Sponsor a Game Night, Bingo or Bowling Event
• Free Hair Cuts Tip: UnitedHealthcare will help pay for this if you can negotiate the price under $10 a person.
• Hold a Free Movie Night for Your Clients if They Bring a Friend

After all your marketing efforts in the community, you have referrals starting to come in. Now, to start the sale, we must determine who is eligible for a Dual SNP.

1. Client must have A&B of Medicare
2. Client must reside in plan service area
3. Client must NOT have ESRD
4. Client must have QMB, QMB+, or Full Benefit Dual Eligible
5. Verify eligibility by calling UnitedHealthcare’s PHD (1-888-381-8581) and acquire the Service Request number, time you called, and the name of the person you spoke with as a reference/proof that you were told they were eligible. When you call PHD you need: consumers name, Medicare and Medicaid number, social security number, date of birth, date in which you were given permission by the client to contact PHD.

Videos: 

Medicare vs Medicaid  |  https://www.medicaremadeclear.com/basics/medicare-vs-medicaid

What is Medicaid  |  https://www.youtube.com/watch?v=N5EovSvIMfE

Websites and Downloads: 

QMB Billing Requirements | https://www.cms.gov/Outreach-and-Education/Outreach/NPC/Downloads/2017-09-19-QMB-FAQ.pdf

Mail you get from Medicare | https://www.medicare.gov/forms-help-and-resources/mail-about-medicare/mail-about-medicare.html

Medicare Interactive; How Medicaid Works with Medicare | https://www.medicareinteractive.org/get-answers/cost-saving-programs-for-people-with-medicare/medicare-and-medicaid/how-medicaid-works-with-medicare

Medicare vs Medicaid Chart | https://www.medicaremadeclear.com/basics/medicare-vs-medicaid

Medicaid and Medicare Enrollee Income Limits on FPL  | https://www.medicaid.gov/medicaid/eligibility/medicaid-enrollees/index.html

2018 FPL CMS Publication | https://www.medicaid.gov/federal-policy-guidance/downloads/cib030618.pdf

MO Transportation Services Catalog  | http://health.mo.gov/atoz/pdf/transportationservices.pdf

Help with Prescription Drug Plans | https://www.ssa.gov/benefits/medicare/prescriptionhelp/

Help with Additional Benefits (food, utilities) | https://www.benefitscheckup.org/

Prescription Manufacture Discounts & Savings Cards | www.Goodrx.com or https://www.needymeds.org/

PACE | http://www.pace4you.org/pace%C2%AE-services  (PACE programs coordinate and provide all needed preventive, primary, acute and long term care services so that older individuals can continue living in the community)

Information on Applying for a Medicare Savings Program | https://www.medicareinteractive.org/get-answers/cost-saving-programs-for-people-with-medicare/medicare-savings-programs-qmb-slmb-qi/applying-for-a-medicare-savings-program

State Pharmaceutical Assistance Programs | https://www.medicare.gov/pharmaceutical-assistance-program/state-programs.aspx

SPAP Basics on Medicare Interactive | https://www.medicareinteractive.org/get-answers/cost-saving-programs-for-people-with-medicare/state-pharmaceutical-assistance-programs-spaps/spap-basics