2024 Dual & Chronic Condition Special Needs Plans (D-SNP/C-SNP) Assessment | Quizlet

Dual Special Needs Plans (D-SNP) are defined as:

Medicare Advantage Plans uniquely designed for consumers enrolled in both Medicare and Medicaid.

Meredith, a D-SNP member, loses Medicaid eligibility. What impact does this have on her D-SNP enrollment?

She will enter a grace period during which she is responsible for plan cost sharing, and she will be disenrolled at the end of the grace period if she does not reestablish Medicaid eligibility.

A D-SNP might be in the best interest of which of these consumers?

Joe, whose low income qualifies him for full Medicaid coverage

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.

Select the statement that best describes a feature of D-SNPs.

D-SNPs are network-based

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:

Selling DSNPs

In general, consumers with Medicare and Medicaid, collectively known as Full Duals, are good candidates for which plan type(s)?

Dual Special Needs Plan

A C-SNP may be most appropriate for:

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

Which statement is true?

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

Which service will a C-SNP or D-SNP member in the high risk Care Management category receive?

Case Management (telephonic, digital and/or face-to-face) according to individual needs

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.

Which statement is true about the Medicaid program?

Benefits vary from state to state.

Which statement is true of D-SNP members?

Members who are Full Dual-Eligible are not required to pay copayments for Medicare-covered services obtained from a D-SNP in-network provider. Their provider should bill the state Medicaid program, as appropriate, for these costs.

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 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