Podcast
Questions and Answers
Which of these are the three types of Special Needs Plans?
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?
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?
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?
Which program is available to support the unique health care needs of CSNP and DSNP members?
Signup and view all the answers
Which statement best describes a DSNP?
Which statement best describes a DSNP?
Signup and view all the answers
When selling DSNPs, what must agents ensure?
When selling DSNPs, what must agents ensure?
Signup and view all the answers
Which consumer may be a good candidate for a DSNP?
Which consumer may be a good candidate for a DSNP?
Signup and view all the answers
Which of the following consumers is best suited for a CSNP?
Which of the following consumers is best suited for a CSNP?
Signup and view all the answers
When can Michael enroll in a different CSNP that also covers diabetes?
When can Michael enroll in a different CSNP that also covers diabetes?
Signup and view all the answers
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?
Signup and view all the answers
What is the purpose of the Chronic Condition Verification form?
What is the purpose of the Chronic Condition Verification form?
Signup and view all the answers
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.
Signup and view all the answers
DSNP members who are QMB+ or Full Dual-Eligible are required to pay copayments for Medicare-covered services.
DSNP members who are QMB+ or Full Dual-Eligible are required to pay copayments for Medicare-covered services.
Signup and view all the answers
How long do plans using the CSNP pre-enrollment verification process have to verify the qualifying chronic condition?
How long do plans using the CSNP pre-enrollment verification process have to verify the qualifying chronic condition?
Signup and view all the answers
What is Lucille's responsibility for cost sharing after losing her eligibility for the DSNP?
What is Lucille's responsibility for cost sharing after losing her eligibility for the DSNP?
Signup and view all the answers
Loss of Medicaid creates a Special Election Period (SEP) for DSNP members.
Loss of Medicaid creates a Special Election Period (SEP) for DSNP members.
Signup and view all the answers
CSNPs and DSNPs do not include Medicare Part D prescription drug coverage.
CSNPs and DSNPs do not include Medicare Part D prescription drug coverage.
Signup and view all the answers
Confirming a consumer's Medicaid level and that they are entitled to Medicare Part A and enrolled in Part B is a requirement of:
Confirming a consumer's Medicaid level and that they are entitled to Medicare Part A and enrolled in Part B is a requirement of:
Signup and view all the answers
Which of the following consumers may not be a good candidate for a DSNP?
Which of the following consumers may not be a good candidate for a DSNP?
Signup and view all the answers
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?
Signup and view all the answers
What cost sharing is a DSNP member responsible for while in the grace period after losing Medicaid status?
What cost sharing is a DSNP member responsible for while in the grace period after losing Medicaid status?
Signup and view all the answers
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.
Studying That Suits You
Use AI to generate personalized quizzes and flashcards to suit your learning preferences.
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.
