Generally, it’s my thought that the best plan for the Dually Eligible individual is a special needs plan which is specifically designed for their situation. However, there may be circumstances where a special needs plan is not available where another Medicare Advantage plan might work.
Here are comments from Coventry on this topic:
Coventry is looking forward to a very exciting and successful new year and to great opportunities to continue our shared success in 2009! It is our goal to continue providing information and tools to support your efforts in assisting Medicare beneficiaries to make informed health care decisions. We want to remind you of some key considerations to guide your interaction with vulnerable populations such as: Medicare-Medicaid dual eligibles, institutionalized beneficiaries, beneficiaries in long-term care or assisted living facilities and seniors with chronic conditions.
Medicare Advantage and/or Part D products may be considered for beneficiaries in vulnerable populations; however, Medicare Advantage plans like Advantra® Freedom Private Fee-For-Service and Coventry’s Advantra® Medicare HMO and PPO plans may not be the best choice for this population.
- Most dual-eligibles have limited financial exposure when enrolling in plans designed specifically for their situations. Our Advantra Freedom Private Fee-For-Service products may increase their financial exposure for covered services in the form of increased copays or coinsurance. Therefore, Advantra® Freedom may not be the best plan choice for dual-eligible beneficiaries. In some counties, Coventry offers Special Need Plans (SNP), such as AdvantraOne®, that are designed specifically to serve dual-eligible beneficiaries. Availability of AdvantraOne plans (by counties) is outlined on the attached.
Agents should not enroll a dual-eligible beneficiary unless the beneficiary contacts their local SHIP (State Health Insurance Assistance Program) to verify their eligibility and to seek counseling on their specific health care options. Marketing and enrollment rules apply, as outlined in the Coventry Agent Training material. You can access that information via the secure broker portal at www.advantrafreedom.com.
- Coventry also offers plans with benefits designed specifically for beneficiaries with chronic conditions like diabetes or high cholesterol. Coventry offers AdvantraExtra® Special Need Plans for beneficiaries with certain chronic conditions. Availability of AdvantraExtra plans (by counties) is also outlined on the attached document below.
- Coventry discourages any form of targeted marketing, including at nursing homes, hospitals, assisted-living facilities and low income and subsidized housing. It is Coventry’s policy that any marketing, sales or educational activities that will be conducted in health care settings and/or residential health and assisted living facilities or low income and subsidized housing must be approved by Coventry in advance to ensure compliance with CMS and Coventry policies. As an added reminder, the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) regulations clearly state that agents/brokers can make marketing presentations and accept enrollment applications only in common areas. Common areas include nursing home cafeterias, community or recreational rooms and conference rooms.
