When selling DSNPs, agents must?
1) Ensure that the consumer only has Medicare
2) Tell the consumer that the DSNP is a zero-dollar premium plan
3) Inform the consumer that the state Medicaid program will pay the Medicare Advantage premiums or copayments
4) Confirm the consumer’s Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Part B
The Correct Answer and Explanation is:
The correct answer is:
4) Confirm the consumer’s Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Part B.
Explanation:
When selling Dual Special Needs Plans (DSNPs), agents must adhere to specific rules and guidelines to ensure they are properly informing consumers and complying with federal regulations. DSNPs are specialized Medicare Advantage plans designed for individuals who are eligible for both Medicare and Medicaid. These plans cater to the unique needs of dual-eligible beneficiaries and provide additional benefits beyond those offered by standard Medicare.
1) Ensure that the consumer only has Medicare:
This statement is incorrect. DSNPs are specifically designed for individuals who are eligible for both Medicare and Medicaid. An agent selling a DSNP must confirm that the consumer is eligible for both programs, not just Medicare. This eligibility is crucial because DSNPs combine Medicare and Medicaid benefits, helping to cover costs that Medicare alone would not cover.
2) Tell the consumer that the DSNP is a zero-dollar premium plan:
This is misleading and not always true. While some DSNPs may have a zero-dollar premium, this is not a requirement for all DSNPs. The agent must ensure that they are accurately representing the plan’s costs. It is important not to make general statements about the plan’s premiums, as they can vary based on the specific plan and the consumer’s eligibility.
3) Inform the consumer that the state Medicaid program will pay the Medicare Advantage premiums or copayments:
This statement is generally accurate, as many Medicaid programs assist with paying premiums, copayments, and deductibles for individuals enrolled in DSNPs. However, the key focus for the agent should be confirming the consumer’s eligibility for both Medicare and Medicaid and verifying their Medicaid level, rather than simply telling them about potential cost savings.
4) Confirm the consumer’s Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Part B:
This is the correct requirement. Before enrolling someone in a DSNP, the agent must confirm the consumer’s eligibility for both Medicare (Part A and Part B) and Medicaid. The individual must be enrolled in both Medicare and Medicaid to qualify for a DSNP. The agent must verify the consumer’s Medicaid level because different states have different Medicaid eligibility requirements, and this affects what benefits the consumer can receive through the DSNP. Properly confirming eligibility ensures that the consumer is legally entitled to the plan and helps the agent avoid potential compliance issues.
In summary, agents selling DSNPs must focus on confirming the consumer’s Medicaid eligibility and ensuring they are entitled to Medicare Part A and enrolled in Part B to ensure compliance with the rules governing these specialized plans.