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Questions and Answers
Confirming the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Medicare Part B is a requirement of?
Confirming the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Medicare Part B is a requirement of?
Selling DSNPs
The consumer states they currently pay a percentage of charges when they receive medical care. This means they are enrolled in a Medicare Supplement Insurance Plan.
The consumer states they currently pay a percentage of charges when they receive medical care. This means they are enrolled in a Medicare Supplement Insurance Plan.
False
Which of the following consumers is best suited for a CSNP?
Which of the following consumers is best suited for a CSNP?
When can Michael enroll in a different CSNP that also covers diabetes, assuming he has not moved out of his current plan's service area?
When can Michael enroll in a different CSNP that also covers diabetes, assuming he has not moved out of his current plan's service area?
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Which is a service provided to a CSNP or DSNP member placed in the low to moderate care management risk level?
Which is a service provided to a CSNP or DSNP member placed in the low to moderate care management risk level?
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What is very important for consumers enrolling in a CSNP to know about accessing providers?
What is very important for consumers enrolling in a CSNP to know about accessing providers?
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The Medicaid program helps pay medical costs for certain groups of people with limited income and resources.
The Medicaid program helps pay medical costs for certain groups of people with limited income and resources.
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Members who are QMB+ or are Full Dual-Eligible are required to pay copayments for Medicare-covered services obtained from a DSNP in-network provider.
Members who are QMB+ or are Full Dual-Eligible are required to pay copayments for Medicare-covered services obtained from a DSNP in-network provider.
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Using the post-enrollment method, when will a new member be disenrolled from their CSNP if a qualifying condition cannot be verified?
Using the post-enrollment method, when will a new member be disenrolled from their CSNP if a qualifying condition cannot be verified?
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What cost sharing are members responsible for if they lose their eligibility for the DSNP due to a change or loss of Medicaid status?
What cost sharing are members responsible for if they lose their eligibility for the DSNP due to a change or loss of Medicaid status?
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What are Dual Special Needs Plans (DSNP)?
What are Dual Special Needs Plans (DSNP)?
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The Special Election Period for Dual/LIS Change in Status begins after the grace period ends for DSNP members that lose Medicaid eligibility.
The Special Election Period for Dual/LIS Change in Status begins after the grace period ends for DSNP members that lose Medicaid eligibility.
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Which consumer might benefit the most by enrolling in a DSNP?
Which consumer might benefit the most by enrolling in a DSNP?
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Which program is available to support the unique health care needs of CSNP and DSNP members?
Which program is available to support the unique health care needs of CSNP and DSNP members?
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What statement best describes a DSNP?
What statement best describes a DSNP?
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What must Melanie's agent confirm for her to enroll in a DSNP?
What must Melanie's agent confirm for her to enroll in a DSNP?
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Larry, who has a qualifying chronic condition, wants a plan that will help him manage his illness and health care costs, may be a good candidate for a DSNP.
Larry, who has a qualifying chronic condition, wants a plan that will help him manage his illness and health care costs, may be a good candidate for a DSNP.
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What is a characteristic of consumers for whom a CSNP may be most appropriate?
What is a characteristic of consumers for whom a CSNP may be most appropriate?
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What service will a CSNP or DSNP member in the high risk care management category receive?
What service will a CSNP or DSNP member in the high risk care management category receive?
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What is the purpose of the Chronic Condition Verification form?
What is the purpose of the Chronic Condition Verification form?
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Consumers enrolling in a DSNP are required to pay copayments for Medicare-covered services from a DSNP network provider if they are Full Dual-Eligible.
Consumers enrolling in a DSNP are required to pay copayments for Medicare-covered services from a DSNP network provider if they are Full Dual-Eligible.
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Lucille's responsibility for cost sharing changes during the grace period after she loses her DSNP eligibility.
Lucille's responsibility for cost sharing changes during the grace period after she loses her DSNP eligibility.
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What are the three types of Special Needs Plans?
What are the three types of Special Needs Plans?
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A Special Election Period (SEP Dual/LIS Change in Status) is available for DSNP members that lose their Medicaid eligibility.
A Special Election Period (SEP Dual/LIS Change in Status) is available for DSNP members that lose their Medicaid eligibility.
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A DSNP might be in the best interest of which of these consumers?
A DSNP might be in the best interest of which of these consumers?
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CSNPs and DSNPs include Medicare Part D prescription drug coverage.
CSNPs and DSNPs include Medicare Part D prescription drug coverage.
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Which consumers may not be good candidates for a DSNP?
Which consumers may not be good candidates for a DSNP?
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Which consumer characteristics demonstrate a good fit for a CSNP?
Which consumer characteristics demonstrate a good fit for a CSNP?
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How is a CSNP or DSNP member's care management health risk levels determined initially?
How is a CSNP or DSNP member's care management health risk levels determined initially?
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Study Notes
Medicare Special Needs Plans (SNPs)
- Confirming Medicaid level and entitlement to Medicare Parts A and B is required for selling Dual Special Needs Plans (DSNPs).
- Chronic Special Needs Plans (CSNPs) cater to consumers with qualifying chronic conditions, such as diabetes.
- Enrollment in CSNP can only occur during Open Enrollment if previously enrolled in another carrier's CSNP.
Medicaid and Cost Sharing
- Medicaid helps cover medical costs for individuals with limited income and resources.
- DSNP members who are Full Dual-Eligible do not pay copayments for Medicare services when using in-network providers; costs should be billed to the Medicaid program.
Care Management and Risk Levels
- Members in low to moderate care management risk levels receive a variety of health services based on risk.
- High-risk CSNP or DSNP members receive tailored case management support to meet their individual health needs.
Eligibility and Enrollment
- Individuals losing Medicaid eligibility after being enrolled in DSNP are subject to all cost-sharing responsibilities, including premiums and deductibles.
- DSNPs are specifically designed for those enrolled in both Medicare and Medicaid, often benefiting those with Qualified Medicaid Beneficiary (QMB+) status.
Special Election Periods (SEPs)
- A Special Election Period is triggered for DSNP members when they lose Medicaid eligibility, allowing them to enroll in alternate plans.
- Verification of chronic conditions for CSNP enrollment requires authorization for the plan to contact the consumer's healthcare provider.
Characteristics of SNP Members
- Ideal candidates for DSNPs include consumers with low incomes qualifying them for full Medicaid or those focused on managing chronic conditions through healthcare plans.
- Members are initially assessed for health risk levels using a Health Assessment aimed at identifying their needs for daily living support.
Prescription Drug Coverage
- Both CSNPs and DSNPs include Medicare Part D prescription drug coverage, ensuring that members have access to necessary medications.
Consumer Guidance
- Agents must ensure that enrolled consumers meet Medicare eligibility criteria and confirm Medicaid levels.
- It’s crucial for consumers to understand the implications of losing Medicaid on their plan coverage and associated costs.
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Description
Test your knowledge and understanding of Medicare and Medicaid with these comprehensive flashcards. Each card presents key concepts and definitions relevant to selling Dual Special Needs Plans (DSNPs). Perfect for those preparing for certification or seeking to reinforce their knowledge in this area.
