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To help differentiate below is an explanation of the two terms:

Medicare:

Federal Health Insurance Program for people 65 years of age or older, some people under age 65 with certain disabilities, and people with end-stage renal disease (kidney failure).

Medicaid:

JOINT Federal AND State government program that helps with medical costs for certain people with limited incomes and resources. Medicaid coverage varies depending on the state and the type of Medicaid level. Each state decides what counts as income and resources as well as determines eligibility. While states can decide how to run their program they have to follow federal guidelines. Example: Some people with Medicaid get help paying for their Medicare premiums and others will get coverage for additional services and drugs not covered by Medicare.

When someone qualifies for both at the same time they are referred to as Dually Eligible.

Why sell a DSNP policy? Many reasons!

These plans typically offer additional coverage such as Dental care, Hearing exams, Vision exams as well as allowances toward eyewear and hearing aids. A big attraction is the Over Counter benefit (OTC). Many carriers provide catalogs to order OTC items with a monthly or quarterly allowance. These are items not covered under the drug plan such as vitamins or first aid supplies. Many carriers have added grocery benefits via meal delivery services or with a specific food card to use in-store. Transportation services to healthcare-related visits are also many times added into the advantage plans.

Besides the added benefits many carriers offer care management in an effort to keep their claims cost down by keeping members healthy. Some examples may be nurse/navigator outreach calls to coach in weight loss, diabetes prevention, hospital discharge instructions as well as making sure members are taking their medications as prescribed. I have even seen social workers help this population find assistance for heating oil as well as discounted durable medical equipment through community services. Many carriers will also have a Health Risk Assessment (HRA) tied to these plans. You can many times earn an additional payout by encouraging your clients to take these surveys which help the carrier identify where managed care may be needed. It is a benefit to your client to be healthy and have assistance and an additional income for you!

Medicaid is still in place and will pick up the left-over copays designated by the carriers. It is important members show both their DSNP ID card AND Medicaid card to their providers and pharmacy. These members will have little to NO out of pocket expense so enrolling in a DSNP policy will only provide them additional benefits and you a commission

Additional Selling Opportunity outside of Open Enrollment!

A benefit as a broker with working this population is they can make plan changes and enroll outside of open enrollment. This will allow you to sell year-round and not be as limited in your selling season. There is a specific Special Election Period (SEP) for those that receive any type of assistance from Medicaid in addition to Medicare. This SEP allows an individual to enroll in or disenroll from an MA/MAPD plan once per calendar quarter and can be used ONCE during each of the following periods:

• January-March
• April-June
• July-September

No SEP is offered during the 4th quarter, however.

Working the DSNP Market

The most common and effective approach to reaching this market is via Grassroots marketing. Involve yourself in community events, soup kitchens, housing authorities, senior centers if you are lucky enough to get into one, and so on! As a benefit to working with Pinnacle, you have retail opportunities which would be a great way to grow your network, (click here to learn more).

Let us help you market and grow this segment!