2025 UHC Dual Eligible and Chronic Condition Special Needs Plans (D-SNP/C-SNP) Assessment

Question 1

The three types of Special Needs Plans are:

Chronic Condition, Dual Eligible and Supplemental

Dual Eligible, Chronic Condition and Private Fee-for-Service

Dual Eligible, Chronic Condition and Institutional/Institutional-Equivalent

Institutional/Institutional-Equivalent, Private Fee-for-Service and Dual Eligible

Question 2

Meredith, a D-SNP member, loses Medicaid eligibility. What impact does this have on her D-SNP enrollment?

She will enter a grace period during which she is responsible for plan cost sharing, and she will be disenrolled at the end of the grace period if she does not reestablish Medicaid eligibility.

There is no impact to her current enrollment.

The only impact is that she will be responsible for plan cost sharing.

Question 3

D-SNP benefits are designed for the consumer who______________.

Does not want to be limited by a network of providers

Is enrolled in their state Medicaid program, typically as a Full Dual, with their Medicare cost sharing paid by the state in which they reside.

Does not need a prescription drug program

Does not need any assistance with home care

Question 4

Which program is available to support the unique health care needs of C-SNP and D-SNP members?

An online chat forum for members to discuss changes to their plan benefits

A Care Management program that varies depending upon the level of the member's health risk

A support group for members to share their health care experiences with each other

Question 5

Select the statement that best describes a feature of D-SNPs.

A member can see any participating Medicaid provider.

D-SNPs do not include prescription drug coverage, so a member may enroll in a stand-alone Prescription Drug Plan in addition to their D-SNP.

There is never a cost to the member when receiving care from a provider, even if the provider is out-of-network.

D-SNPs are network-based.

Question 6

Melanie wants to enroll in a D-SNP. Which of the following must her agent do?

Confirm that Melanie is entitled to Medicare Part A, enrolled in Part B, and her Medicaid level.

Tell Melanie that the D-SNP is a zero-dollar premium plan.

Ensure that Melanie only has Original Medicare.

Inform Melanie that the state Medicaid agency will pay the Medicare Advantage premiums or copayments.

Question 7

In general, consumers with Medicare and Medicaid, collectively known as Full Duals, are good candidates for which plan type(s)?

Private Fee-for-Service Medicare Advantage Plan

Medicare Supplement and stand-alone Prescription Drug Plan

Dual Eligible Special Needs Plan

Question 8

Which Medicare-eligible consumer is best suited for a C-SNP?

Barbara, who has resided in a contracted Skilled Nursing Facility for more than 90 days

Jeremy, who is low income and needs extra help with cost sharing

Edwin, who has not been diagnosed with a chronic condition

Mary, who has been seeing a specialist for a qualifying chronic condition

Question 9

John, 68, is currently enrolled in a Medicare Supplement Plan with a stand-alone Prescription Drug Plan. Newly diagnosed with a chronic condition, he calls agent Charles on May 3 to ask if there are plans that will help him manage his condition. Can John enroll in a C-SNP that covers his chronic condition?

Yes, he can enroll using Medicare Supplement Insurance Guaranteed Issue.

Yes, he can enroll using his Special Election Period (SEP-Special Need/Chronic).

No, he can only enroll during the Annual Election Period (AEP).

No, he can only enroll during the Medicare Advantage Open Enrollment Period (MA-OEP).

Question 10

Which of the following are Care Management Plan components provided to a C-SNP or D-SNP member placed in the low to moderate Care Management risk level?

All of the responses are correct.

Ongoing reassessment of risk level for status changes

Individualized Care Plan (ICP)

Initial Health Assessment

Question 11

It is very important for consumers enrolling in a C-SNP to know the following about accessing providers:

Some C-SNPs are Preferred Provider Organization (PPO) or Point of Service (POS) Plans that allow members to see out-of-network providers for covered services, generally with higher cost sharing.

Members are never charged more when seeing out-of-network providers.

Any provider who accepts Medicare will automatically accept a C-SNP member.

Question 12

Which statement is true about the Medicaid program?

All states must refer to the program as "Medicaid" and not by any other name.

It helps pay medical costs for certain groups of people with limited income and resources.

The federal government determines what programs are operated and funded.

It is strictly a federal program.

Question 13

You must advise Full Dual Eligible consumers enrolling in a D-SNP that:

Once the plan pays for the member's covered services, the provider should bill the member for any remaining balances instead of the state Medicaid program.

Generally, they are not required to pay copayments for Medicare-covered services received from a D-SNP in-network provider if they are Full Dual-Eligible in the state in which they reside. Their provider should bill the state Medicaid program, as appropriate, for these costs.

They must disenroll from Medicaid to enroll into the D-SNP, but they can go to any Medicare participating provider.

Question 14

Ginny just enrolled in a C-SNP that uses the post-enrollment verification method. When will the plan send her a termination notification letter if it has not yet been able to verify a qualifying chronic condition?

At the end of a six-month grace period

30 days after the last attempt to contact the provider

At the end of her first month of enrollment

Question 15

A D-SNP member loses his eligibility due to a change or loss of Medicaid status. What cost sharing is he responsible for while in the grace period?

Only Part B premiums

No change occurs during the grace period

All, such as premiums, deductibles, copayments, and coinsurance

Only coinsurance and copayments

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