With the lock-in period in full swing, you’re probably hearing more about Dual Eligible Special Needs Plans (D-SNPs) lately.
Whether you’re new to D-SNPs or searching for information to fine-tune your selling techniques, this quick guide will cover all the basic information you need to know about these valuable, multifaceted products.
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What are D-SNPs?
D-SNPs are a type of Medicare Advantage (MA) Special Needs Plan. Most D-SNPs are health maintenance organization (HMO) plans, though some are preferred provider organization (PPO) plans. There are five types of D-SNPs: All-Dual, Full-Benefit, Medicare Zero Cost Sharing, Dual Eligible Subset, and Dual Eligible Subset Medicare Zero Cost Sharing.
Each state determines which D-SNPs a carrier can offer and the benefits they can include. Generally speaking, D-SNPs include the following:
- Care coordination
- $0 monthly premiums
- Over-the-counter quarterly benefits
- Dental, vision, and hearing benefits
- Transportation benefits
- Gym memberships
- Telehealth services
Who Qualifies for D-SNPs?
Dual-eligibles, individuals of any age who are eligible for both Medicare and Medicaid, qualify for D-SNPs.
To be eligible for Medicare, individuals must be 65 years old or older or have a qualifying disability. To be eligible for Medicaid, an individual’s income and asset level must fall below certain thresholds determined by their state.
The type of plan a dual-eligible can enroll in depends upon the Medicaid category they fall under. The cheat sheet below helps explain these eligibility restrictions.
|Type of D-SNP||Who’s Eligible to Enroll|
|All-Dual||Any dual-eligible beneficiary|
|Full-Benefit||Dual-eligibles who qualify for full Medicaid benefits for the month under any eligibility category or Medical assistance for any month if the individual was eligible for assistance in any part of the month|
|Medicare Zero Cost Sharing||Dual-eligibles who aren’t responsible for cost-sharing for Medicare Parts A or B (QMB, QMB+ beneficiaries)|
|Dual Eligible Subset||Members of certain groups of dual-eligibles determined by a carrier’s coordination with a State Medicaid Agency|
|Dual Eligible Subset Medicare Zero Cost Sharing||Members of certain groups of dual-eligibles determined by a carrier’s coordination with a State Medicaid Agency who aren’t responsible for Medicare cost-sharing|
Remember, always verify a client’s Medicaid eligibility before enrolling him or her in a D-SNP. Many D-SNP carriers have agent support personnel who can assist you with this task.
Remember, always verify a client’s Medicaid eligibility before enrolling him or her in a D-SNP.
When Can You Sell D-SNPs?
Even though D-SNPs are MA plans, they have no set enrollment period. Why? Because when someone becomes eligible for a D-SNP, they qualify for a Special Enrollment Period (SEP) to join one. And as long as they maintain their eligibility for Medicare and Medicaid, they have an SEP to join or switch D-SNPs once during each of the first three calendar quarters of the year. This makes selling these plans a great way to unlock sales outside of the Annual Enrollment Period.
Where Can You Find D-SNP Prospects?
D-SNP prospects are all around you, especially if you work near an urban or generally low-income area. If you sell near a large rural area, it will be more difficult to find prospects because CMS won’t allow D-SNPs in counties that don’t have a certain number of doctors. It will also be difficult to find clients if you do business near moderately to highly wealthy areas, since the type of prospects you’re looking for wouldn’t be able to afford living there.
Since welfare programs and Social Security disburse payments near the beginning of the month, you should be able to find D-SNP prospects in places where dual-eligibles spend money during the first half of the month. During the second half of the month, you should be able to find them at places where dual-eligibles seek assistance.
First Half of the Month:
- Dollar stores (e.g., Dollar Tree, Dollar General, and Family Dollar)
- Discount stores (e.g., Walmart, Kmart, PriceRite, etc.)
- Thrift shops and flea markets
Second Half of the Month:
- Food pantries
- Food banks
- Soup kitchens
Anytime Throughout the Month:
- Utility assistance locations
- Community events (e.g., senior expos and health fairs)
- Charity events
- Churches or other faith-based organizations
- Areas with low-income housing
- Senior centers
- Retirement communities
Looking to find more prospects? Give these strategies for growing your insurance sales territory a try
How Can You Build Your D-SNP Business?
To build your D-SNP book of business, you’ll want to focus your efforts on two main objectives: utilizing grassroots marketing and providing superior customer service.
Utilizing Grassroots Marketing
Taking a grassroots marketing approach is the most effective way to get D-SNP leads and build your D-SNP client base.
Taking a grassroots marketing approach is the most effective way to get D-SNP leads.
Grassroots marketing involves going out into the community where prospective clients are, engaging with them, as well as forming relationships with other professionals in the community who can refer prospective clients to you. Some strategies include:
- Volunteering at food banks, food pantries, soup kitchens, and charity events
- Visiting community centers, retirement communities, and areas with low-incoming housing
- Hanging tear-off flyers or business cards on bulletin boards at indoor flea markets, thrift stores, or churches
- Forming partnerships with churches, provider offices, non-profit organizations, and retailers
- Setting up your own booth at community events
- Holding educational events and sales events
In the words of one successful D-SNP agent, “Position yourself in the community as a resource, and people will come to you.”
Note: You MUST follow all CMS Medicare Communications and Marketing Guidelines for marketing these plans and holding events. For more information on how to stay compliant, check out our do’s and don’ts of Medicare compliance.
Providing Superior Customer Service
Treating people right will increase your chances of converting prospects into clients, getting referrals from existing clients or professionals within your community, and retaining clients.
You can provide superior customer service by:
- Becoming well-informed on the subjects you hear prospects and clients asking questions about
- Educating your prospects and clients on their health insurance programs and options
- Making sure your clients understand their plans and benefits and how to access their care
- Letting your prospects or clients know about other people or organizations who can help them with their non-health insurance related needs (when appropriate)
How Can You Retain D-SNP Clients?
The fact that dual-eligibles can join or switch D-SNPs every calendar quarter can be a double-edged sword. On one hand, it gives you the opportunity to find new MA clients anytime throughout the year. On the other, it gives other agents the opportunity to simultaneously swoop in and steal your clients.
In order to avoid losing your D-SNP clients, ensure you:
- Establish trust with them. Be someone they know they can come to with health insurance questions.
- Provide them with superior customer service. Do everything you can to help them (while maintaining a professional relationship) and communicate effectively (in person and digitally).
- Confirm they’ll know how they can best reach you when they have a question. Give them your phone number and email address. Tip: Fridge magnets are harder to lose than a business card.
- Follow-up with them every six months to one year. Check how they’re doing, if their income or prescription drug needs have changed, and if they still feel that their plan is meeting their needs.
Taking these measures can help you build client loyalty. Don’t forget, the smallest of actions can make a huge difference in the lives, and minds, of others.
Why Sell D-SNPs?
You’ve learned that selling D-SNPs can earn commissions during Medicare’s off-season, but there’s one point we need to make clear: If you’re only interested in selling these products for your own profit, you may quickly find that you’re not working in the right market.
The dual-eligible population can be difficult to work with. Out in the field, you’ll encounter many people confused by their health insurance options. Your ability to explain things in an easy-to-understand manner and effectively answer questions will be tested. You may even find yourself in houses that make you cringe in a state of discomfort.
Simply put, agents who sell D-SNPs do so because they truly want to help others through their business. You should sell them if you want to do the same.
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Contracting with D-SNPs can open the door to many new opportunities for your business. To learn more about these products or to find out which ones are most competitive near you, send us a message.
Editor’s Note: This article was originally published in January 2017. It has been updated to reflect changes relevant to 2019.