Medicare dual eligible sales
This information is for Medicare dual eligible sales. In general, this is an under-served market. There is no annual enrollment period for these plans, so you can sell them year round. Unfortunately, this population is always growing. You need to be aware of the needs of your potential clients and make sure you incorporate that into your product. You can do this by developing a marketing program that shows them what this program can do to make their lives better.
What are Medicare dual eligible sales?
To start, Dual eligible or DSNPs are a type of Medicare Advantage special needs plan. Most DSNPs are HMO plans, although there are a few PPO Plans.To qualify as Dual Eligible (Duals) you must meet certain income amounts. Certain low-income individuals are entitled to receive benefits from both federal and State Medicaid programs. There are over 18 million elderly as well as disabled Americans who are currently supported by these programs.
For those who qualify, Medicare covers their acute care services. Medicaid covers both Medicare premiums and cost sharing. Certain members will also qualify for long-term care services, dental, vision as well as some other services. Supplemental benefits vary by state. Medicare is the primary payer, Medicaid is secondary. This means, Medicaid pays supplemental coverage, premium and helps with cost sharing. They also help pay for services not covered by Medicare.
Medicaid is important for the dual eligible population because, it reduces out-of pocket expenses giving them access to needed health care.
Many types of people are dual eligible; including people with chronic conditions, difficulties with daily living activities, cognitive impairments like dementia, physical disabilities, developmental disabilities as well as severe mental illness. There are also healthy people who qualify as dual eligible, because they are 65 or older and their income falls below a certain level. Medicare beneficiaries who either meet specific income levels and/or have high medical expenses can qualify to receive Medicaid. In some cases, the beneficiary has a large number of medical expenses that reduce their net income level. In this instance the recipient would be classified as medically needy. The qualifications and benefits vary according to each state.
Although DSNPs are MA plans, there is no set enrollment period. If your client/prospect becomes eligible for a DSNP, they qualify for a Special Enrollment Period (SEP). During the time they qualify for Medicare and Medicaid, they can either join or switch DSNP plans one time during each of the first 3 quarters of the year. This gives agents more sales opportunity outside open enrollment.
Finding potential DSNP clients:
There are plenty of DSNP prospects that can use your help with health insurance. They are easier to find in low-income areas. Rural areas will most likely have fewer prospects due to the fact that there are less doctors in these areas. CMS rules do not allow DSNPs in counties that don’t have a large number of doctors. You will have a hard time finding DSNP clients in wealthy areas because people with a lower income cannot afford to live in those areas.
You can find prospects in stores that are known to have lower cost items such as; dollar stores and Walmart or Kmart for example. You can also find them in food pantries, soup kitchens in low income housing, senior centers or retirement communities. When you find a area where prospects are available, you need to connect with them. Let them know you are there to help them get the care they need.
It is always good to build relationships with other community professionals who can refer prospective clients to you. Let people know you are a valuable resource for them.
Some ways to become active in the community are:
Host some educational events that will introduce your services. You can set up a table at events to give people the information they need.
Spend time volunteering at food pantries or soup kitchens.
Go to the local community center or retirement center.
Place your business cards where they can be seen and taken by prospective members.
How to Retain DSNP Clients:
Because Dual-eligible clients can either join or switch DSNPs every calendar quarter, you have an opportunity to find new MA clients during the year. Be advised; this also means other agents have a chance to steal your clients by offering them better coverage options.
If you want to retain your DSNP clients make sure you follow these guidelines:
- Make sure they know you have their best interest in mind. They need to be able to trust you and come to you if they have any concerns.
- Give them all the attention they need to feel confident that you are there to help them.
- Be sure to give them easy ways to reach you either by phone or email, if they have questions or concerns. Refrigerator magnets work well and are always easy to find.
- Keep in contact with your clients always follow up with them, make sure they know you have not forgotten about them. Ask them if they have had any changes in income or health needs. Make sure they have the coverage they need.
Click here to down load the CMS guide to Dual eligible Medicare/Medicaid beneficiaries
To see income charts for qualifying levels by state CLICK HERE
There are different levels of Medicaid beneficiaries
There are 2 types of Medicaid recipients. Some people qualify for Full Benefit Dual Eligible (FBDE) which is why we are talking about Medicare dual eligible sales. The other level of Medicaid recipients is referred to as MSP or (Medicare Savings Program). Although Medicaid coverage rules vary by state, there is a basic group of services that every state must cover. These include doctor and hospital visits. The rest of the benefits are state specific. Certain states cover dental, vision and therapy. Some states have limits on some services.
If a client qualifies for Medicaid, they also qualify for Low Income Subsidy (LIS). This program gives individuals help with prescription drug costs.
PLEASE NOTE: If an individual qualifies for LIS that does not mean they are automatically eligible for Medicaid too.