Questions and Answers
Which of these are the three types of Special Needs Plans?
When does the Special Election Period for Dual/LIS Change in Status begin for DSNP members that lose Medicaid eligibility?
The month after they are notified by the plan of the loss of Medicaid eligibility.
A DSNP might be in the best interest of which of these consumers?
Joe, whose low income qualifies him for full Medicaid coverage.
Which program is available to support the unique health care needs of CSNP and DSNP members?
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Which statement best describes a DSNP?
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When selling DSNPs, what must agents ensure?
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Which consumer may be a good candidate for a DSNP?
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Which of the following consumers is best suited for a CSNP?
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When can Michael enroll in a different CSNP that also covers diabetes?
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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?
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What is the purpose of the Chronic Condition Verification form?
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The Medicaid program helps pay medical costs for certain groups of people with limited income and resources.
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DSNP members who are QMB+ or Full Dual-Eligible are required to pay copayments for Medicare-covered services.
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How long do plans using the CSNP pre-enrollment verification process have to verify the qualifying chronic condition?
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What is Lucille's responsibility for cost sharing after losing her eligibility for the DSNP?
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Loss of Medicaid creates a Special Election Period (SEP) for DSNP members.
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CSNPs and DSNPs do not include Medicare Part D prescription drug coverage.
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Confirming a consumer's Medicaid level and that they are entitled to Medicare Part A and enrolled in Part B is a requirement of:
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Which of the following consumers may not be a good candidate for a DSNP?
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How is a CSNP or DSNP member's care management health risk levels determined initially?
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What cost sharing is a DSNP member responsible for while in the grace period after losing Medicaid status?
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Study Notes
Special Needs Plans Overview
- Three types of Special Needs Plans (SNPs): Dual, Chronic Condition, and Institutional/Institutional-Equivalent.
Dual Special Needs Plan (DSNP) Key Points
- Special Election Period (SEP) for DSNP members losing Medicaid eligibility starts the month after notification.
- DSNP is suitable for consumers like Joe, who qualifies for full Medicaid coverage due to low income.
- Agents selling DSNPs must confirm that consumers are Medicare entitled and check their Medicaid status.
Chronic Condition Special Needs Plan (CSNP) Insights
- Programs exist to support the specific health care needs of CSNP and DSNP members, based on health risk levels.
- A suitable candidate for a CSNP is Mary, who has a chronic condition and sees a specialist regularly.
Enrollment and Eligibility
- Michael can switch CSNPs during the Annual Election Period (AEP) or Open Enrollment Period (OEP) if he remains in the same service area.
- Plans utilizing the CSNP pre-enrollment verification process must confirm chronic conditions within 21 days or by the end of the month of the request.
- CSNPs and DSNPs include Medicare Part D prescription drug coverage.
Cost Sharing and Benefits
- DSNP members, particularly those who are QMB+ or Full Dual-Eligible, face no copayments for services within the network.
- If Lucille loses her Medicaid eligibility, she becomes responsible for all cost-sharing aspects, including premiums and copayments.
Health Risk Assessment
- Initial health risk levels for CSNP or DSNP members are determined via a Health Assessment, evaluating health status and daily living assistance needs.
- DSNP members losing Medicaid eligibility must bear check costs like premiums and copayments during the grace period.
Important Forms and Processes
- The Chronic Condition Verification form enables plans to confirm the presence of qualifying chronic conditions by contacting providers.
- Loss of Medicaid creates an opportunity for DSNP members to utilize the Special Election Period for adjustments.
Candidate Suitability
- Consumers like Anne, who do not incur out-of-pocket charges for medical care, are good DSNP candidates, while Maria, who does have charges, may not qualify.
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Description
Test your knowledge on UHC's Chronic Condition and Dual Special Needs Plans with these flashcards. Each card presents key terms and definitions to enhance your understanding of Special Needs Plans and their eligibility criteria.
