DSNP members cannot switch plans outside of AEP and OEP in 2025

[m10509]

if the state has a contract with any managed medicaid plan for people on medicare ( which most states do) and that insurance company also offers a DSNP then their DSNP is either a FIDE or HIDE plan.HIDE are much more common than FIDE .Most of the big carriers have medicaid contract for people on original medicare.One big exception in Florida is Aetna

Medicare Advantage dual eligible special needs plans

Dual eligible special needs plans (D-SNPs) are a type of Medicare Advantage plan designed to meet the specific needs of dually eligible beneficiaries. Originally authorized as part of the Medicare…

www.macpac.gov

OK so does that mean, ?

 

[DonP]

OK so does that mean, ?

Ask your state reps with United or other carriers that sell duals . They'll know if you have integrated plans coming . I'll say this . Your dsnps will be calling you soon if your date goes to integrated plans . Your clients will get a letter from Medicaid in July asking what Medicaid carrier they want listing the available carriers . If they chose known they natch then up with the dsnp they have if they offer Medicaid on their state

 

[Special Agent]

I don't believe FIDE or HIDE is a new thing - what is new for 2025 is that we as agents have to concern ourselves with this if we want to enroll a DE on original medicare outside of AEP and OEP

If a DSNP carrier has a medicaid managed care plan in the state for people on original medicaid ( in fl there called MMA) then their DSNP is usually a HIDE.Lets say a person with original medicare and wellcare MMA in Florida wants to enroll in a DSNP plan after OEP in 2025 using the SEP-integrated plan election code they could enroll in Wellcare DSNP,or Humana DSNP or UHC DSNP since all these carriers currently have MMA medicaid contract in Florida.After the one time use of the SEP -Integrated Plan for the year they are locked in other than the misc. SEPS like FEMA,change of address,change of status etc

 

[m10509]

Ask your state reps with United or other carriers that sell duals . They'll know if you have integrated plans coming . I'll say this . Your dsnps will be calling you soon if your date goes to integrated plans . Your clients will get a letter from Medicaid in July asking what Medicaid carrier they want listing the available carriers . If they chose known they natch then up with the dsnp they have if they offer Medicaid on their state

I asked 2 yesterday, said they have no plan details for 2025

 

[Baseball7]

There's always an sep

 

[Special Agent]

I asked 2 yesterday, said they have no plan details for 2025

Have you ever spoken to a DE prospect on original medicare in MI and asked them who is manages their medicaid side? You can also do a medicaid verification on the aetna think agent and it gives you the name of the medicaid managed care plan and some state medicaid automated lines will tell you what plan they are enrolled in if you have a ss and dob and permission of course.

 

[m10509]

Have you ever spoken to a DE prospect on original medicare in MI and asked them who is manages their medicaid side? You can also do a medicaid verification on the aetna think agent and it gives you the name of the medicaid managed care plan and some state medicaid automated lines will tell you what plan they are enrolled in if you have a ss and dob and permission of course.

OK so what does this all mean, dsnp members are going to all be moved to these integrated plans?

 

[Special Agent]

OK so what does this all mean, dsnp members are going to all be moved to these integrated plans?

No

SEP maintaining LIS/Medicaid election code which can be used to switch or enroll no longer available in 2025 so anybody already on a DSNP plan after 3/31/25 cannot switch plans

DE who have original medicare can enroll in PDP or FIDE or HIDE DSNP ( SEP Integrated Plan) after 3/31 and are locked in after that for the rest of the year

 

[myinsurebiz]

This thread is why we sub out our Medicare. Done gave me a headache