In the past, Dual-Eligible Special Needs (DSNP) clients, other people who receive Medicaid assistance (QMB-only, SLMB-only, etc.), and LIS clients could make changes to their plans every single month of the year that would become effective in the following month.
In 2019 and moving forward, those clients have new SEP rules. Basically, AEP rules now apply to DSNP and LIS beneficiaries in the same way that they apply to everyone else.
For contract year 2020, the Centers for Medicare and Medicaid Services (CMS) has issued new guidelines for SEPs for Dual-Eligibles and LIS.
Now your clients can only make one change per quarter for the first three quarters (January – September) of the year. Your clients may not use one of these SEPs during the fourth quarter of the year (October – December), but can participate in AEP.
For the first three quarters, if your client makes a change, the coverage will take effect the month after he or she enrolls. The SEP will be considered “used” when your client makes an election.
For example, if your LIS client enrolls in a new Medicare Advantage plan on March 10, the coverage will take effect April 1.
During Q4, however, general AEP rules apply. For example, if you submit an application with an AEP election period code for a DSNP client on November 1, their plan will not become effective until January 1, with the rest of your AEP enrollees.
You can still sell to DSNP and LIS-eligible clients from October to December for 1/1 effective dates during the AEP. However, you must use the AEP election period code on the applications (unless they have another non-income based SEP that requires coverage to begin before 1/1).
That means you must sell on or before December 7 in order for coverage to take effect on January 1.
It also means that you should NOT be waiting until December 8 to focus on your DSNP and LIS clients. Please wait until January 1 to start submitting these income-related SEP applications again. Focus your time from December 7 through December 31 on initial enrollments and other types of SEP enrollments, instead!
If you’ve never sold DSNPs before, here’s a brief overview.
A Dual-Eligible Special Needs Plan is a type of Medicare Advantage plan that offers health benefits to people who are eligible for both Medicare and Medicaid. Coverage can vary by carrier, but DSNPs often provide:
LIS stands for Low-Income Subsidy, and it’s a federal program that helps Medicare enrollees pay for prescription drugs. LIS is also known as Medicare Extra Help. The program has financial eligibility requirements (the client’s income must be at or below 150 percent of the Federal Poverty Level). The Medicare Extra Help Program helps cover some of the following benefits:
DSNPs may be low or no cost for your clients. However, insurance carriers can still pay you high commissions. Selling DSNPs is a great benefit for both the licensed agent and the client because not only do you help someone receive quality healthcare, you get to make money doing it.
At Senior Market Advisors, we give our agents the tools to be top earners. A partnership with us means that you get an experienced sales and marketing team to help you generate leads. You also get extensive sales training, contracts with all of the major carriers, and free CRM access.
We also keep you up-to-date on the latest CMS changes so you can inform your clients and help them get the best health coverage possible. Ready to start? Call 1-844-452-5020 or eContract with us today.