2023 Dual and Chronic Condition Special Needs Plans (D-SNP/C-SNP) Assessment

She is not required to pay copayments for Medicare-covered services when she uses a provider in the D-SNP network because she is Full Dual Eligible. Her provider should bill the state Medicaid program, as appropriate, for these costs.

Alice is Full Dual Eligible and is enrolling in a D-SNP. What should her agent remind her about? Once the plan pays for her covered services, the provider should bill Alice for any remaining balances instead of the state Medicaid program. She must disenroll from Medicaid to enroll into the D-SNP. She can go to any Medicare participating provider. She is not required to pay copayments for Medicare-covered services when she uses a provider in the D-SNP network because she is Full Dual Eligible. Her provider should bill the state Medicaid program, as appropriate, for these costs.

Selling D-SNPs

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: Disenrolling from a D-SNP Selling C-SNPs Selling any health insurance plans Selling D-SNPs

Medicare Advantage Plans uniquely designed for consumers enrolled in BOTH Medicare and Medicaid.

Dual Special Needs Plans (D-SNP) are defined as which of the following: Medicare Advantage Plans uniquely designed for consumers enrolled in BOTH Medicare and Medicaid. Medicare Advantage Plans uniquely designed for Medicare consumers with specific long-term illnesses. Medicare Advantage Plans uniquely designed for Medicare consumers residing in contracted Skilled Nursing Facilities. Medicare Advantage Plans uniquely designed for consumers enrolled in EITHER Medicare or Medicaid.

The member completes a Health Assessment that asks a series of questions about their health status and assistance they may need with activities of daily living.

How is a C-SNP or D-SNP member's care management health risk levels determined initially? The member is given a physical conducted by an approved provider. The member is assigned a risk level based on their chronic condition only. The member is automatically put into a risk level category based on age. The member completes a Health Assessment that asks a series of questions about their health status and assistance they may need with activities of daily living.

Within 21 days of the request for additional information or the end of the month in which the enrollment request is made (whichever is longer).

How long do plans using the C-SNP pre-enrollment verification process have to verify the qualifying chronic condition until they must deny the enrollment request? Within 21 days of the request for additional information. By the end of the month in which the enrollment request is made. Within 21 days of the request for additional information or the end of the month in which the enrollment request is made (whichever is longer). Within 7 days of the request for additional information.

Some C-SNPs are Preferred Provider Organization (PPO) or Point of Service (POS) Plans that allow members to see out-of-network providers for covered services, generally with higher cost sharing.

It is very important for consumers enrolling in a C-SNP to know the following about accessing providers: Members are never charged more when seeing out-of-network providers. Some C-SNPs are Preferred Provider Organization (PPO) or Point of Service (POS) Plans that allow members to see out-of-network providers for covered services, generally with higher cost sharing. Members can see any Medicare participating provider. Any provider who accepts Medicare will automatically accept a C-SNP member.

Yes, he can enroll using his Special Election Period (SEP-Special Need/Chronic)

John, 68, is currently enrolled in a Medicare Supplement Plan with a stand-alone Prescription Drug Plan. Newly diagnosed with a chronic condition, he calls agent Charles on May 3 to ask if there are plans that will help him manage his condition. Can John enroll in a Chronic Special Needs Plan (C-SNP) that covers his chronic condition? No, he can only enroll during the Medicare Advantage Open Enrollment Period (OEP) Yes, he can enroll using his Special Election Period (SEP-Special Need/Chronic) No, he can only enroll during the Annual Election Period (AEP) Yes, he can enroll using Medicare Supplement Insurance Guaranteed Issue

Confirm that Melanie is entitled to Medicare Part A, enrolled in Part B, and her Medicaid level

Melanie wants to enroll in a D-SNP. Which of the following must her agent do? Tell Melanie that the D-SNP is a zero-dollar premium plan Inform Melanie that the state Medicaid agency will pay the Medicare Advantage premiums or copayments Confirm that Melanie is entitled to Medicare Part A, enrolled in Part B, and her Medicaid level Ensure that Melanie only has Original Medicare

All, such as premiums, deductibles, copayments, and coinsurance

Members who lose their eligibility for the D-SNP due to a change or loss of Medicaid status are responsible for what cost sharing? Only Part D premiums The same cost sharing as before they lost eligibility All, such as premiums, deductibles, copayments, and coinsurance Only Part A premiums

She will enter a grace period during which she is responsible for plan cost sharing, and she will be disenrolled at the end of the grace period if she does not reestablish Medicaid eligibility.

Meredith, a D-SNP member, loses Medicaid eligibility. What impact does this have on her D-SNP enrollment? There is no impact to her current enrollment. The only impact is that she will be responsible for plan cost sharing. The only impact is disenrollment at the end of a grace period unless she reestablishes Medicaid eligibility. She will enter a grace period during which she is responsible for plan cost sharing, and she will be disenrolled at the end of the grace period if she does not reestablish Medicaid eligibility.

Consumers who have a qualifying chronic condition, are focused on their health issues and may have concerns with having to manage their illness or dealing with multiple providers

The following is a characteristic of consumers for whom a C-SNP may be most appropriate: Consumers who have a qualifying chronic condition, are focused on their health issues and may have concerns with having to manage their illness or dealing with multiple providers Consumers who are still working and receive health care coverage through their employer or union Consumers who have Medicare and Medicaid Consumers who have resided in a contracted Skilled Nursing Facility for more than 90 days

Mary, who has been seeing a specialist for a qualifying chronic condition

Which of the following consumers is best suited for a C-SNP? Barbara, who has resided in a contracted Skilled Nursing Facility for more than 90 days Mary, who has been seeing a specialist for a qualifying chronic condition Jeremy, who is low income and needs extra help with cost sharing Edwin, who has not been diagnosed with a chronic condition

Maria, who pays a percentage of charges when she receives medical care

Which of the following consumers may not be a good candidate for a D-SNP? Susannah, who has a permanent disability and receives Supplemental Security Income (SSI) Frank, who lives in subsidized housing and receives help with his heating bills Maria, who pays a percentage of charges when she receives medical care Jeff, who receives the meals on wheels community service

A care management program that varies depending upon the level of the member's health risk level

Which program is available to support the unique health care needs of C-SNP and D-SNP members? A support group for members to share their health care experiences with each other Gift cards for every year of enrollment An online chat forum for members to discuss changes to their plan benefits A care management program that varies depending upon the level of the member's health risk level

The monthly premium is at or below the Low Income Subsidy benchmark to cover drug costs

Which statement best describes a D-SNP? D-SNPs are non-network based plans, which enables members to see any Medicare-eligible provider The monthly premium is at or below the Low Income Subsidy benchmark to cover drug costs The state government pays half of the plan premium D-SNPs do not include prescription drug coverage, so a member may enroll in a stand-alone Prescription Drug Plan in addition to their D-SNP

Is enrolled in their state Medicaid program, typically as a Full Dual, with their Medicare cost sharing paid by the state in which they reside.

Which statement describes the primary characteristic of a consumer who may benefit from a D-SNP? Does not need any assistance with home care Is enrolled in their state Medicaid program, typically as a Full Dual, with their Medicare cost sharing paid by the state in which they reside. Does not need a prescription drug program Does not want to be limited by a network of providers

The provider indicated on the form does not have to be contracted with the plan.

Which statement is true about provider information on the Chronic Condition Verification Form? The provider indicated on the form must be a specialist. The provider indicated on the form does not have to be contracted with the plan. The provider indicated on the form must be the primary care provider. The provider indicated on the form must be contracted with the plan.

It helps pay medical costs for everyone who applies for it.

Which statement is true about the Medicaid program? It helps pay medical costs only for individuals 65 and older. Regardless of the state, it is always referred to as Medicaid. Benefits vary from state to state. It helps pay medical costs for everyone who applies for it.

They are not required to pay copayments for Medicare-covered services received from a D-SNP network provider if they are Full Dual-Eligible or determined DSNP eligible by our plan agreement with the state in which they reside. Their provider should bill the state Medicaid program.

You must advise consumers enrolling in a D-SNP that: They can go to any Medicare participating provider. Once the plan pays for the member's covered services, the provider should bill the member for any remaining balances instead of the state Medicaid program. They are not required to pay copayments for Medicare-covered services received from a D-SNP network provider if they are Full Dual-Eligible or determined DSNP eligible by our plan agreement with the state in which they reside. Their provider should bill the state Medicaid program. They must disenroll from Medicaid to enroll into the D-SNP.