What must an agent confirm for a client wishing to enroll in a DSNP?

For a client wishing to enroll in a Dual-Eligible Special Needs Plan (DSNP), it is essential for an agent to confirm the client’s eligibility for both Medicaid and Medicare Part B. DSNPs are specifically designed for individuals who qualify for both Medicare and Medicaid, allowing them to receive coordinated care tailored to their unique needs.

Confirming eligibility helps ensure that the applicant meets the necessary criteria to enroll in the plan, as it provides the framework for the benefits offered under a DSNP. This step is vital because if the client does not meet these eligibility requirements, they cannot enroll in the DSNP and will not receive the associated advantages designed to assist dual-eligible individuals, such as prescription drug coverage and managed care services.

Other options like confirming the client’s health insurance history or willingness to pay higher out-of-pocket costs, while potentially relevant in certain contexts, do not specifically address the fundamental requirement for enrollment in a DSNP. Residency status in the service area may be important for some plans, but again, the primary focus for DSNP enrollment lies in verifying the dual eligibility for Medicaid and Medicare.