In 2021 almost 13 million people had health care through Medicare and Medicaid. These dual eligible individuals have the option of receiving care through Medicare Advantage plans for dual-eligible individuals, known as Dual-Eligible Special Needs Plans (D-SNPs). These plans are touted as coordinating care for beneficiaries between the two programs. A recent KFF report that highlights important trends in Dual-Eligible Special Needs Plans, states that 5.2 million dual-eligible individuals were enrolled in (D-SNPs) in 2023. KFF found that as of 2023 most D-SNP enrollees were in coordinated-only (CO) plans, “that are required to provide the minimum level of coordination between Medicare and Medicaid but are not fully integrated within the same plan.” KFF also found in the report that while there are fewer Prior Authorization (PA) requests in D-SNPs than in MA in general, when a PA is required by a D-SNP they are denied twice as often as in MA in general. As enrollment in D-SNPS increases, more data and study is necessary to determine if the care provided by D-SNPS actually improves coordination of care and outcomes for those dually eligible.
KFF issue report can be found at:10 Things to Know About Medicare Advantage Dual-Eligible Special Needs Plans (D-SNPs). Some points from the report:
- About 3 in 10 (29%) dual-eligible individuals enrolled in D-SNPs in 2021.
- The share of dual-eligible individuals enrolled in D-SNPs varies by state, ranging from 5% (Nevada) to 58% (Hawaii) in 2021.
- The average dual-eligible individual could choose from 10 D-SNPs in 2022.
- About half (52%) of D-SNP enrollees were in UnitedHealthcare or Humana plans in 2023.
- D-SNPs are more likely than other Medicare Advantage plans to offer some extra benefits such as over the counter benefits and meal benefits.
- In 2021, dual-eligible individuals enrolled in a plan in a D-SNP-only contract were subject to one prior authorization request, on average. Despite the fact that there are fewer Prior Authorization (PA) requests in D-SNPs than in MA in general, when a PA is required by a D-SNP they are denied twice as often as in MA in general.
March 21, 2024 – K. Kertesz