top of page

Changes are coming for Dual Special Needs Plans (DSNP)


Man with cane

Earlier this year in 2023, the state of Indiana awarded four payers to manage Indiana’s Medicare and Medicaid population. This contract will span over four years with a value of $3.8 billion.[1]


What does this new structure look like?

The new look of Indiana Dual Special Needs Plans breaks out plan options into three types of Dual Special Needs Plans. This means the four carriers who were awarded the contract, Molina Healthcare of Indiana, UnitedHealthcare, Humana Health Horizons, and Anthem Blue Cross, will all follow the same layout of plans.


Three plan types

  • Plan Type # 1

    • Age 60+

    • Medicaid Level = FBDE (Full-Benefit Dual Eligible), QMB+, SLMB+

  • Plan Type # 2

    • Age <60

    • Medicaid Level = FBDE (Full-Benefit Dual Eligible), QMB+, SLMB+

  • Plan Type # 3

    • Medicaid Level = QDWI, QMB, SLMB, or QI

In descending order from the first plan type to the last we can assume that the supplemental benefits will decrease in value to the member.


How does this effect current Dual Eligible Members?

  1. QMB Only members

    1. Before this change, members with QMB Only were able to enroll in the same Dual Special Needs Plans as FBDE, QMB+, and SLMB+. Therefore, the individuals with QMB Only will have DECREASED supplemental benefits.

    2. QMB Only members will still have cost-sharing in plan type #3

  2. Dual Special Needs Plans with enrollments who didn’t win the bid?

    1. These plans will not go away for 2024, however, they will not allow any new enrollments. Those who are enrolled who do not make a switch to another Dual Special Needs Plan will be “grandfathered” into that plan.

Perfiniti Tip:

We highly recommend meeting with an Agent during the Annual Enrollment Period to move to one of the new Dual Special Needs Plans for 2024


What do current Dual Special Needs Plan members need to do during the Annual Enrollment Period?

  • Meet with your agent!

  • Every member will want to meet with their agent to ensure you are enrolling in the correct plan for 2024. If you do not complete an enrollment by December 7th, the carriers who won the bid will “cross-walk” you into the Dual Special Needs Plan that you qualify for automatically.

Perfiniti Tip:

We do not recommend you let this happen and strongly suggest you take a proactive approach in reviewing all carrier options available to you given your age and Medicaid level


Conclusion:

This change in the Dual Special Needs Plan market in Indiana will have bumps in the road at first and certainly there will be confusion. In the long-run, this will be a positive decision and we are already hearing other states will follow this model.


If you have questions or need help during the Annual Enrollment Period please call and schedule a time to meet with our Licensed Agent.


Definitions:

Qualified Medicare Beneficiary (QMB)

The Qualified Medicare Beneficiary Program is one of the four Medicare Savings Programs that allows you to get help from your state to pay your Medicare premiums. This Program helps pay for Part A premiums, Part B premiums, and deductibles, coinsurance, and copayments.


Specified Low-Income Medicare Beneficiary (SLMB)

Specified Low-Income Medicare Beneficiary is a Medicare Savings Program (MSP) administered by each state's Medicaid program. It pays the Medicare Part B premium for people with Medicare who have limited income and assets.


Qualifying Individual (QI)

The Qualifying Individual program is one of four Medicare Savings Programs (MSPs) administered by Medicaid. What does QI pay for? This program covers the Medicare Part B premium. QI income limits can vary between states.


Qualified Disabled Working Individual (QDWI)

What does QDWI stand for in Medicare? It refers to Qualified Disabled Working Individual, and it's one of four Medicare Savings Programs (MSPs). QDWI covers the Medicare Part A premium for working individuals under age 65 who have a disability and do not qualify for premium-free Part A.


[1] Wilson, Rylee. “Indiana awards 4 payers $3.8B managed-care contract.” Becker’s Payer Issues, 17 Mar. 2023, https://www.beckerspayer.com/contracting/indiana-awards-4-payers-3-8b-managed-care-contract.html

34 views0 comments

Comments


bottom of page