Dual Eligible Outreach and Advocacy is not a new initiative in Medicare Advantage. Back in the early 2000s many of us on the BeneLynk management team were working on Dual Enrollment at a company called Social Service Coordinators. Then, as now, Medicare Advantage plans had many reasons to implement comprehensive programs to help their low-income members qualify for the Medicare Savings Programs and/or Full Medicaid. For the member, it potentially means increased benefits, lower copays, and a rebate of the Medicare Part B premium. For the Medicare Advantage plan, securing Dual enrollment for more members means an appropriate increase in capitation and a stickier member. More and more health plans are interested in addressing the Social Determinants of Health of members. One of the most immediate and positive impacts for Medicare Advantage members is to give them access to additional income by enrolling them in a program to rebate their Medicare Part B premium.
Every Medicare Advantage plan should have a robust strategy to help members secure and retain Dual enrollment. But participation rates, defined by the amount of the eligible population who are actually enrolled in Dual programs, remain far too low. As you can see from the following graphic, Medicaid participation rates range from a high of 63% (for Full Medicaid) to a low of 15% (for the Qualifying Individual Medicare Savings Program).
Why are participation rates still so low?
- Awareness: Many seniors and adults with disabilities simply do not know that they are eligible for Medicaid programs. The Medicare Savings Programs in particular are not widely understood. Many seniors do not know that they qualify for a rebate of their Part B premiums and could use the monthly savings of $105 to $135.50 to pay for things that promote their health such as food and medication.
- Misperceptions: Whether it is the general misperception that Medicaid programs are “not for them” or more specific misperceptions about “Medicaid Estate Recovery” too many seniors have misunderstandings about how Medicaid programs work. A lack of information can prevent seniors from accessing the benefits they deserve. Since January 2010, estate recovery is not allowed for the Medicare Savings Programs. Even for Full Medicaid recipients, many states only attempt to recover the cost of long-term care services paid by Medicaid and not the cost of regular Medicaid services provided in the community. In addition, states can’t begin recovery efforts during the life of surviving spouses or children who are under age 21 or disabled, and states will defer recovery if it would cause undue hardship to heirs. Helping members to understand Medicaid Estate Recovery can allay unwarranted concerns.
- Help needed: Seniors and disabled adults, and in particular those who may qualify for Medicaid programs, face a wide range of challenges that make successful completion of the relevant application and paperwork difficult. States’ Medicaid application and renewal forms and processes can be complex, and proof of income and assets is usually required.
At BeneLynk we take a new approach to Dual Enrollment and lead with help! Our goal is aligned with yours, to increase your Dual Enrollment penetration and member tenure. Any service can help some members enroll in Medicaid programs. We judge ourselves by our ability to get (and keep) as many Medicare Advantage members as possible enrolled in the benefits they deserve.
- Cast a wide net: We start with a predictive algorithm calibrated using our decades of experience. But, ultimately, we know that the best way to find as many people as possible who are Dual Eligible, is to have conversations with as many potentially eligible members as possible. We build awareness, and correct misperceptions, by talking to a wide range of Medicare Advantage members. Our on-shore, live-agent process builds the trust Medicare Advantage members need to learn about Medicaid programs.
- Lead with a positive member experience: A member that is engaged personally and professionally is more likely to be open to a discussion of possible benefits. BeneLynk solves challenges for all members thereby improving your member’s experience.
- Get members the most in benefits: Our engagements start with our Community Lynk services. We ask members what we can do to help first and link them with select programs from a database of over 150,000 local, state, and federal programs. Our service goes beyond education, by assisting your members with programs that can overcome the barriers to living their healthiest lives.
- Hands-on assistance throughout the Medicaid application process: We help members who appear to qualify for Medicaid and/or the Medicare Savings Programs navigate the complicated state application and verification processes. We also advocate on their behalf as needed to ensure any state errors that occur are promptly corrected.
- Low-Income Subsidy (Extra Help) Advocacy: With the ever-increasing cost of prescription medicine in this country, medication adherence continues to be a problem for many seniors and can impact your cost of care and your quality metrics. Benelynk helps members determine eligibility and become enrolled in the Low-Income Subsidy (Extra Help), State Prescription Assistance Programs and a library of other Pharmacy Assistance Programs to remove financial barriers to maintaining their prescription regime.
- Know your Veterans: Lastly, many of our seniors are also Veterans of the US Armed Forces. Benelynk uncovers if these members are using VA services as health plan might be missing out on potential Dx or other important information on their members health. Benelynk also maintains a library of assistance programs specifically for our veterans.
The success of a Dual Eligible outreach program is ultimately measured by its ability to get as many people as possible the benefits that they deserve. At BeneLynk, we have structured our services to reflect this commitment.
As always, we are excited to talk about our Dual Lynk program or Social Determinants of Health in general. If you want to chat, please drop us a note today at Sales@BeneLynk.com
About the Author
Sean Libby has been an advocate for seniors, people with disabilities, veterans, and individuals with low income for over 17 years. At BeneLynk, we are committed to helping managed care plans to deliver superior Social Determinant of Health solutions to their members. We are always looking to learn more and would like to hear your ideas on how best to assist members in need. Drop us a note at Sales@BeneLynk.com.