Dual Special Needs Plans (DSNPs) coordinate coverage for individuals who are eligible for both Medicare and Medicaid (also known as dual eligibles). These individuals are often left to navigate a confusing coordination of benefits and program rules, which can result in duplication of services and incorrectly matched care settings. This can also reduce access as providers opt-out due to administrative burdens, leading to poorer health outcomes.
Through default enrollment, state Medicaid agencies can enroll newly Medicare-eligible individuals into an aligned DSNP if they are already enrolled in an affiliated Medicaid managed care plan through the same parent company. This minimizes member confusion around selecting and enrolling in a Medicare plan, and ensures that the individual receives efficient care coordination.
As of 2021, only a few states have implemented default enrollment for their DSNPs. Let’s take a look at how the process works to benefit both members and states.
Benefits for stakeholders
Default enrollment has many advantages for stakeholders, and members who are automatically enrolled into aligned care experience higher satisfaction. Aligned enrollment also occurs in a sustainable and measured process, which gives us the time to ensure that members and providers are educated on eligible benefits before the transition.
Additionally, default DSNP enrollment typically results in a low opt-out rate and low rapid disenrollment rate, which creates stability in a state’s market. All members who are default enrolled are provided a Special Enrollment Period (SEP) to protect member choice. That way, individuals can switch to a Fee-for-Service (FFS) model or another Medicare Advantage product if they do not wish to be enrolled in the aligned DSNP.
Supporting default enrolled members
The default enrollment process doesn’t end once a person is enrolled in the DSNP. It’s critical to support members through the entire transition period, starting from the original notice 60 days before enrollment through exploring and using their benefits. Changing plans is a big change for many members, and we never want them to feel surprised, overwhelmed or confused by the change.
We use a specific identifier in our internal systems to tag and keep track of default enrolled individuals. This indicates that conversations with the individual need to be more descriptive, as they may not be aware of their benefits or what it means to have both Medicare and Medicaid coverage with one company. When these proactive steps are in place, we have observed low rapid disenrollment and opt-out rates.
Streamlining the transition to default enrollment
Engaging states early in the enrollment process is critical to a successful transition, especially because every state enrollment file is slightly different. We have found that when states send a separate data file that includes only members eligible to be enrolled through default, the data exchange is more streamlined than if we work with existing files like the Benefit Enrollment and Maintenance Transaction Set (834) or HIPAA Eligibility Transaction System (270/271) formats.
Even though default enrolled members don’t have the typical sales agent relationship, it’s still important for sales agents to know about the DSNP and the default enrollment process. If members can’t get answers to their questions when speaking to an agent about their plan and enrollment, they may use the SEP to enroll in a different plan.
Helping states transition to default enrollment
We have found that retention rates are better the more the DSNP knows about Medicaid and how a person enrolls. By knowing which benefits members heavily use, we continue to offer and build on the most useful benefits to improve health outcomes.
UnitedHealthcare currently leverages default enrollment in three states (Arizona, Tennessee and Virginia) and will be implementing the model in New York later in 2021. Setting up default enrollment relies heavily on a partnership between the health plan and the state. State engagement is critical to ensuring an effective process, which includes design, implementation and ongoing administration.
At the end of the day, we want members to be in the product that is best for them. Default enrollment is a streamlined way for states to enroll members consistently and sustainably in the DSNP and simplify the member experience — all while protecting a person’s right to choose how they receive care.