Connect with D-SNP members who will be disenrolled due to loss of eligibility.
As you know, Dual Eligible Special Needs Plans (D-SNPs) are designed for people who qualify for both Medicare and Medicaid (“dual eligibles” or “dually eligible individuals”). CMS requires carriers to confirm eligibility of D-SNP enrollees on an ongoing basis. At Aetna, this typically happens once a month, but the process was interrupted earlier this year due to the Change Healthcare outage. We are now restarting that monthly D-SNP eligibility verification process for all states outside of New Jersey and Virginia. (Eligibility verification was not disrupted in New Jersey and Virginia and has continued without interruption in those states.)
What you need to know
If D-SNP members are newly identified as losing their eligibility, they will receive a letter with information about their options. View letter (E32).
Members who were previously notified about their loss of eligibility, and who have not regained their eligibility, will be disenrolled from their plan effective January 31, 2025. These members will receive a letter and an outreach phone call.
- “Loss of eligibility” reminder letters mailed on December 14. These members received an initial “loss of eligibility” letter from us before we halted the monthly verification process. This new letter (E32a) explains members will be covered by Original Medicare beginning February 1, unless they join another plan by January 31, 2025. It also outlines options for selecting new coverage, including using a one-time Special Election Period.
- Outreach phone calls: Our vendor Benelynk will call every impacted member to offer help reapplying for Medicaid or re-establishing eligibility, or guidance on selecting other coverage. The caller ID will show “Benelynk” and their number: 866-977-6344.
- If members wish to enroll in a non-SNP Aetna Medicare plan, they will be transferred to Aetna Teleoksales for assistance.
- If Aetna Telesales assists them with enrolling in a new “like” plan by the end of the year, your AOR status will be maintained. Review our AOR retention policy for details.
How you can help
You are encouraged to contact your impacted membership directly to help them enroll in another plan that will best meet their needs in 2025.
Or you can encourage them to respond to the letter or phone call they receive.
To receive a list of your impacted clients, please reach out to your upline or local Aetna Medicare Broker Manager.
Remember, unless members take action to enroll in a new plan, they will be reverted to Original Medicare. While members are eligible for an SEP, once they revert to Original Medicare, you will need to initiate the re-enrollment for your clients to reestablish yourself as the AOR.
Overview of the SEP for individuals who lose special needs status
This SEP allows individuals enrolled in a special needs plan (SNP) to enroll in a Medicare Advantage plan, when they no longer meet the applicable special needs status to remain enrolled in the SNP. The SEP for an individual who loses special needs status begins the month the individual’s special needs status changes and ends three calendar months after the effective date of the involuntary disenrollment from the SNP.
Questions?
To learn more, reach out to your local Aetna Medicare Broker Manager and they’ll be happy to assist.
The information on this website is for agent use only and not intended for the general public.
