2026 D-SNP/C-SNP Assessment

UNITED MEDICARE

What are Dual Eligible Special Needs Plans (D-SNP)?

• Medicare Advantage Plans uniquely designed for consumers enrolled in either Medicare or Medicaid.

• Medicare Advantage Plans uniquely designed for Medicare consumers residing in contracted Skilled Nursing Facilities.

• 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 consumers enrolled in either Medicare or Medicaid.

When does the Special Election Period for Dual/LIS Change in Status begin for D-SNP members that lose Medicaid eligibility?

• Six months after they have been disenrolled from the D-SNP

• Upon notification or effective date of the loss, whichever is earlier

• The month after they are notified by the plan of the loss of Medicaid eligibility

• After the grace period ends

• Upon notification or effective date of the loss, whichever is earlier

Which consumer might benefit the most by enrolling in a D-SNP?

• Joe, who receives Qualified Medicaid Beneficiary benefits (QMB+)

• Alvin, who has a Medicare Supplement policy

• Alice, who has Original Medicare ONLY

• Elsa, who pays a Part D income-related monthly adjustment amount (IRMMA)

• Alice, who has Original Medicare ONLY (NOT)

Of the election periods listed, which one can Full Dual-Eligible consumers use to enroll in an Integrated D-SNP in July?

• SEP - Integrated Care

• Medicare Advantage Open Enrollment Period (MA OEP)

• SEP - Dual/LIS Maintaining

• SEP - Dual/LIS Maintaining (NOT)

Which statement is true about C-SNPs, D-SNPs and prescription drug coverage?

• C-SNPs and D-SNPs do not include Medicare Part D prescription drug coverage.

• C-SNPs and D-SNPs only cover drugs for diabetics.

• C-SNPs and D-SNPs only offer coverage for generic drugs.

• C-SNPs and D-SNPs include Medicare Part D prescription drug coverage.

• C-SNPs and D-SNPs include Medicare Part D prescription drug coverage.

When selling D-SNPs, agents must:

• Inform the consumer that the state Medicaid program will pay the Medicare Advantage premiums or copayments.

• Ensure that the consumer only has Medicare.

• Confirm the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Part B.

• Tell the consumer that the D-SNP is a zero-dollar premium plan.

• Confirm the consumer's Medicaid level and that the consumer is entitled to Medicare Part A and enrolled in Part B.

With which of these consumers might you want to explore the possibility of a D-SNP enrollment?

• All of the above

• Jeff, who receives the meals on wheels community service

• Maria, who receives state help with Medicare cost-sharing and additional services not covered by Medicare

• Frank, who lives in subsidized housing and receives help with his heating bills

• All of the Above

Which Medicare-eligible consumer 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

• Jeremy, who is low income and needs extra help with cost-sharing (NOT)

Which statement is true?

• Chronic Condition Special Needs plans do not require verification of a qualifying condition from a provider.

• Agents may complete a Chronic Condition Special Needs Plan enrollment application if the consumer indicates their provider will be able to verify their chronic condition.

• In order to enroll in a C-SNP, consumers must provide proof of their chronic condition before an application can be submitted.

Agents may complete a Chronic Condition Special Needs Plan enrollment application if the consumer indicates their provider will be able to verify their chronic condition.

What program is available to support members of a C-SNP and D-SNP who may have unique health care needs?

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

• A care management program that assigns a care manager to each member regardless of the member's health risk level

• A care management program only for members who have two or more complex medical conditions

• A care management program that varies depending upon where the member lives

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

It is very important for consumers enrolling in a C-SNP to know the following about accessing 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 are never charged more when seeing out-of-network providers.

• Any provider who accepts Medicare will automatically accept a C-SNP member.

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.

Which statement is true about the Medicaid program?

• It helps pay medical costs for certain groups of people with limited income and resources.

• The only eligibility requirement is that the consumer is under the age of 65.

• Benefits are exactly the same from state to state.

It helps pay medical costs for certain groups of people with limited income and resources.

Which statement is true of D-SNP members?

• Generally, members who are Full Dual-Eligible are not required to pay copayments for Medicare-covered services obtained from a D-SNP in-network provider in the state in which they live.

• They must disenroll from Medicaid to enroll into the D-SNP, but they can go to any Medicare participating provider.

• Once the plan pays for their covered services, their provider should bill the member for any remaining balances instead of the state Medicaid program.

• Generally, members who are Full Dual-Eligible are not required to pay copayments for Medicare-covered services obtained from a D-SNP in-network provider in the state in which they live.

How long do plans that use the C-SNP pre-enrollment verification process have to verify the qualifying chronic condition until they must deny the enrollment request?

• Within 7 days of the request for additional information

• 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)

• 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)

Lucille is no longer eligible for her state Medicaid program and has lost her eligibility for the D-SNP in which she is enrolled. What is her responsibility for cost-sharing?

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

• Only Part A premiums

• Only deductibles and copayments

• No change occurs during the grace period

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

The three types of Special Needs Plans are:

• Dual-Eligible, Chronic Condition and Private Fee-for-Service

• Chronic Condition, Dual-Eligible and Supplemental

• Dual-Eligible, Chronic Condition and Institutional

• Institutional, Private Fee-for-Service and Dual-Eligible

• Dual-Eligible, Chronic Condition and Institutional

When does the Special Election Period for Dual/LIS Change in Status begin for D-SNP members that lose Medicaid eligibility?

• The month after they are notified by the plan of the loss of Medicaid eligibility

• Upon notification or effective date of the loss, whichever is earlier

• After the grace period ends

• Six months after they have been disenrolled from the D-SNP

D-SNP benefits are designed for the consumer who______________.

• Does not need a prescription drug program

• Does not need any assistance with home care

• Does not want to be limited by a network of providers

• Is eligible for Medicare and Medicaid

• Is eligible for Medicare and Medicaid

What qualifies an eligible consumer to use the Integrated Care SEP?

• Must be Full Dual-Eligible consumer who lives within the Integrated plan service area and is enrolling in an Integrated plan

• Must be an LIS Only consumer

• Any Dual-Eligible consumer can qualify

Must be Full Dual-Eligible consumer who lives within the Integrated plan service area and is enrolling in an Integrated plan

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 any health insurance plans

• Selling C-SNPs

• Selling D-SNPs

Selling D-SNPs

A C-SNP may be most appropriate for:

• Consumers who have resided in a contracted Skilled Nursing Facility for more than 90 days

• 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 Medicare and Medicaid NOT

Which statement is true about the Medicaid program?

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

• It helps pay medical costs only for individuals 65 and older.

• Benefits vary from state to state.

• Benefits vary from state to state.

Alice is a Full Dual-Eligible receiving full cost-sharing from the state. What should her agent remind her about?

• She can go to any Medicare participating provider.

• 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 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.

• 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.

Using the post-enrollment method, when will a new member be disenrolled from their C-SNP if a qualifying condition cannot be verified?

• 30 days after the last attempt to contact the provider

• At the end of the second month of enrollment

• At the end of the first month of enrollment

• After a 6-month grace period

At the end of the first month of enrollment (NOT)