2025 Dual Eligible and Chronic Condition Special Needs Plans (D-SNP/C-SNP) Assessment (UHC) | 15 questions and answers + rationales ( 100% accuracy )

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

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

Which statement is true about how the loss of Medicaid affects a member's enrollment in a D-SNP?

Special Election Period (SEP Dual/LIS Change in Status) is available for D-SNP members and they will be responsible for all cost sharing.

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

Joe, whose low income qualifies him for full Medicaid coverage

Which statement best describes a Care Management program that varies depending upon the level of the member's health risk?

Support provided to C-SNP and D-SNP members that may have unique health care needs

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

D-SNPs are network-based.

Melanie wants to enroll in a D-SNP. Which of the following must her agent do?

Confirm that Melanie is entitled to Medicare Part A, enrolled in Part B, and her Medicaid level.

The consumer states they currently pay a percentage of charges when they receive medical care. This means:

The consumer is not likely to be a Full Dual-Eligible and may be better suited for enrollment in a type of plan other than a D-SNP.

Which characteristic best describes a good fit for a C-SNP?

A consumer with a qualifying chronic condition who wants a plan that will help them manage their illness and health care costs

Which statement is true?

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.

How is a C-SNP or D-SNP member's Care Management health risk level determined initially?

The member completes a Health Assessment (HA) that asks a series of questions about their health status and any assistance needed with daily living activities.

The Chronic Condition Verification form/questions authorizes the plan to do what?

It authorizes the plan to contact the provider identified on the form in order to verify that the consumer has at least one of the qualifying chronic conditions covered by the C-SNP.

Which statement is true about the Medicaid program?

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

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

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. Her provider should bill the state Medicaid program, as appropriate, for these costs.

Ginny just enrolled in a C-SNP that uses the post-enrollment verification method. When will the plan send her a termination notification letter if it has not yet been able to verify a qualifying chronic condition?

At the end of her first month of enrollment

Members who lose their eligibility for the D-SNP due to a change or loss of Medicaid status are responsible for what cost sharing?

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