Assessing the Value of D-SNP Enrollment for Partial-Benefit Dually Eligible Individuals
- About 22 percent of individuals dually eligible for Medicare and Medicaid with partial benefits (more than one of every five) were enrolled in Dual Eligible Special Needs Plans (D-SNPs) in 2020, an increase from 17 percent in 2018.
- About 30 percent of D-SNP enrollees were partial-benefit dually eligible (PBDE) individuals, which remained largely constant during the three-year period.
- Each year, about 8 to 9 percent of PBDE individuals became full-benefit dually eligible (FBDE) individuals. Among those who transitioned from partial to full benefits, about 18 percent were enrolled in D-SNPs in 2020, an increase from 12 percent in 2018.
- The distribution of D-SNP enrollment and switching to full benefits from partial benefits varied by state and individual characteristics, including age, sex, race and ethnicity, original reason for entitlement, and urbanity (that is, urban versus rural residence).
PBDE individuals are Medicare enrollees who are also eligible for Medicaid assistance with Medicare premiums (and in some cases, Medicare cost sharing) but are not eligible for other state Medicaid benefits. In all states that operate Medicare Advantage D-SNPs, FBDE individuals have the option to enroll. PBDE individuals also have the option of enrolling in a D-SNP in most states. Yet little is known about PBDE individuals’ enrollment in D-SNPs. In this report, we examined the share of PBDE individuals enrolled in D-SNPs, D-SNP enrollment patterns among PBDE individuals across states and individual characteristics, and PBDE individuals who transition to full benefits. We found that D-SNPs are a growing Medicare coverage type for PBDE individuals, with the proportion of PBDE individuals enrolled in D-SNPs rising from 17 percent in 2018 to 22 percent in 2020, which is more than one of every five PBDE individuals. About 30 percent of D-SNP enrollees were PBDE individuals, which remained largely constant during the three-year period. In addition, about 50,000 individuals in 2020 who were enrolled in a D-SNP (or one of every six PBDE individuals) switched to full benefits. The distribution of D-SNP enrollment and switching to full benefits from partial benefits varied by state and individual characteristics.