What is a requirement when selling a DSNP?

When selling a Dual Special Needs Plan (DSNP), it is essential to confirm the consumer's level of state Medicaid and entitlement to Medicare. DSNPs are specifically designed for individuals who qualify for both Medicaid and Medicare, thus it is crucial to establish the individual's eligibility for these programs prior to enrollment. This ensures that the consumer receives the appropriate benefits and services tailored to their unique healthcare needs and financial situation.

Determining the consumer’s eligibility not only helps in compliance with regulations but also aids in providing the necessary support for accessing healthcare services effectively. This requirement aligns with the overarching objective of DSNPs, which is to coordinate care for individuals with dual eligibility and facilitate their access to the medical and prescription drug benefits they require.