If you’re a producer working on new business or managing a large portfolio, you’ll need to understand these upcoming changes and what they mean for you.

How Producers Will Be Affected These changes might present both hurdles and chances for producers dealing with dual-eligible plans. While some modifications are limited, others are clarified, altering the landscape for those deeply involved with dual-eligible clients.

Access to Resources

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Key Changes Overview

The CMS final rule introduces considerable adjustments affecting full dual eligible beneficiaries, partial dual eligible beneficiaries, and LIS-only members. These changes will be effective from January 1, 2025, and apply during the annual period when you are writing new businesses.

Quarterly Update Elimination: The quarterly election period for full duals, partial duals, and LIS-only members will be removed, transitioning to a more structured framework moving forward.

New Monthly SEPs: A significant shift is the introduction of monthly SEPs. These will enable beneficiaries to make specific changes more frequently:

• Disenrollment Options: Beneficiaries can disenroll from an MAPD to revert to original Medicare and enroll in a standalone drug plan.
• Drug Plan Adjustments: Monthly adjustments are allowed for standalone drug plan changes within the year.
• DSNP Plan Changes: Full dual eligibles can change to an integrated DSNP plan, emphasizing the need to identify integrated and aligned DSNPs.

Emphasizing DSNP Plan Integration Levels

These changes necessitate understanding DSNP integration levels. Full dual eligibles can migrate to fully integrated Dual Eligible Special Needs Plans (FI-SNP), Highly Integrated Dual Eligible Special Needs Plans (HIDE-SNP), or other applicable integrated plans (AIP).

Alignment and Future Considerations

Aligned enrollments will become increasingly critical, potentially restricting DSNP enrollments to aligned options by 2027. Understanding the relationship between Medicaid managed care organizations (MCOs) and DSNPs is vital, as these affiliations will determine eligible enrollment.

State-Specific Dynamics

Producers should be aware that the availability of eligible dual plans may vary significantly across states. Many states primarily offer coordination-only plans, limiting election use for full duals if integrated options aren’t available.

Conclusion

As we move into 2025, it’s vital to stay on top of the new regulations and understand all the nuances. Producers need to keep updated on the status of DSNP plans and make the most of the existing SEPs and resources to maximize dual enrollment and retention strategies.

If you have any questions or need further clarification, give us a call at 1-800-772-6881. And don’t forget to check out our YouTube channel for the latest updates. Stay informed and prepared as we head into 2025 to maintain your edge in the insurance industry.