Engaging with those who are Dual-Eligible for both Medicare and Medicaid To Strengthen Relationships and Encourage Loyalty

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1 Engaging with those who are Dual-Eligible for both Medicare and Medicaid To Strengthen Relationships and Encourage Loyalty #StartwithHealthy

2 Who Is Eligible For a D-SNP? The term Dual Eligible (the D in the acronym) is used to encompass all Medicare beneficiaries who also receive Medicaid assistance. SNP stands for Special Needs plans, plans designed to provide targeted care and services to individuals with unique needs. 1 Medicare eligibility is based generally on a person s age or disability, Medicaid assistance is provided based on financial need. While dual eligibility requires both factors, an increase in income can result in disenrollment. 2 If a member s income rises above the eligibility threshold for any reason, they can be involuntarily disenrolled from the plan MILLION people are fully or partially DUAL-ELIGIBLE 5 61 % of Dual-eligibles ARE FEMALE 5 Medicare Eligible Dual Eligible Medicaid Eligible 45 % of Dual-eligibles DID NOT GRADUATE FROM HIGH SCHOOL 5 Dual-eligibles use more in-patient, emergency room, home health and skilled nursing facility services than non-duals. 5 2

3 Dual Eligible Special Needs Plans In the overlap between Medicare and Medicaid is the medical plan known as a D-SNP. People who qualify for both Medicare and Medicaid are generally over the age of 65 and have low incomes. 1 Patients who are dual eligible for Medicare and Medicaid are in a vulnerable population that needs to be handled with care. They live on limited means and many are reaching the end of their lives. 2 They require patience and reinforcement to help them access the medical services for which they are eligible. 2 One feature of D-SNPs that can be problematic for carriers is that members can switch plans at any time, not just during the Medicare Advantage and Prescription Drug plan annual election period. 3 The down side is that some seniors are easily influenced to switch for the wrong reasons or without fully understanding the ramifications of their decision. 3 Education and clear communication are the keys to helping D-SNP members obtain quality medical care. 3

4 I can hear you fine. I just can t understand you. Dual-eligibles typically value simple, personalized communication Within this demographic, there is a distinct preference for personal communication either by phone or face to face. 3 Healthcare and insurance are complex issues, and they want someone to help walk them through the details. 3 In most cases, a phone conversation provides the greatest level of comfort. Members can ask specific questions and get clarification on what they don t understand. 3 While there are many questions that can be answered with a quick online search, that is not usually their go-to source for information. Dual-eligible seniors didn t grow up with computers or the Internet, and there is a wide range of online literacy within this group. 4 Work to establish a relationship with members, providing courteous, compassionate and complete assistance when they call. 4

5 Keep On Keepin On As they age, dual-eligible patients place greater importance on good health and insurance 3 Mobility is key to good health and independence for people of all ages. Like anyone else, dual eligibles want to continue living independently and doing the things they enjoy. 3 Most in this group feel positive about having medical insurance because it allows them to take care of health issues that they may not be able to afford otherwise. Still, they find the complexity of the system to be daunting at times. 3 Automated billing and phone systems can be confusing, especially when an older person can t get their questions answered or are told that someone will call them back. It is common for these dual eligibles to disenroll from a plan and switch to a another one if they become dissatisfied or frustrated with poor customer service. 3 Provide D-SNP patients with re-enrollment reminders to help them avoid involuntary disenrollment. 5

6 Why They Switch Voluntary disenrollment is often centered around unresolved customer service issues 3 Dual-eligible seniors value prompt, complete and courteous customer service. If they have to navigate a complicated call center or wait too long for return phone calls, they may switch to a different plan. 3 Keeping their current physicians or specialists is extremely important to this demographic. If a member s preferred doctors are not covered on a D-SNP, they may choose a carrier that allows them to continue seeing their doctors. 3 Failure to re-enroll annually while often unintentional is still considered voluntary disenrollment. 3 Seniors who were previously in an employer s health insurance plan may not realize that they need to re-enroll for the D-SNP. If they are disenrolled, they may not find out until they go to pick up a prescription or visit their doctor and are told they are not covered. 3 If a member calls to disenroll, provide assistance and guidance to help resolve their complaints. 6

7 Building Partnerships to Create Loyalty Dual-eligible patients are extremely vulnerable to suggestions and may switch to a different plan if someone offers what sounds like a better deal. 3 Phone calls, TV ads and door-to-door sales have a great influence on this population. They are easily persuaded to switch plans, and even a suggestion that they might not be adequately insured is enough to make them switch. 3 Education and frequent communication from their insurance carrier can help alleviate dual-eligible seniors concerns about not having the right health insurance coverage. When they feel a sense of partnership, members are less likely to be swayed by poachers from another plan. Written communication must be easy to comprehend. Keep the terminology simple and consider providing it in Spanish as well as English. 3 7

8 Building a strong relationship with these folks is integral because you need to build a level of trust with these clients so that they can see you as their advisor. Be more than just an agent. Kelly Ridgeway, Insurance Agent and Medicare Specialist 1 Beneficiaries_Dual_Eligibles_At_a_Glance.pdf, February 2017, Accessed 24 July CMS Manual System, Pub Medicare Managed Care, Department of Health & Human Services (DHHS), Centers for Medicare & Medicaid Services (CMS), Accessed 24 July Humana, D-SNP Disenrollment Qualitative Research Report 4 Computer Anxiety and Computer Self-Efficacy of Older Adults, April 2015, Accessed 24 July Open Minds D-SNP report, CMS, 2017 MedPAC Dual Eligible Factpack For Agent use only. Confidential and proprietary information, do not disseminate.