Entering the Dual Eligible Market? 5 Things for Payers to Consider

Changes in the US dual eligible landscape, patients who qualify for both Medicare and Medicaid, have complicated things for payers looking to crack into the market. In a new article on Health Payer Intelligence, Kelsey Waddill discusses 5 important things for payers interested in the dual eligible market to consider beforehand to ensure market success. The first is the increasingly picky dual eligible special need plan enrollment process.

According to Waddill, “In 2025, fully integrated dual eligible special need plans will only be able to enroll full-benefit dual-eligible beneficiaries. Moreover, fully integrated dual eligible special need plan enrollees must have Medicaid coverage from the Medicaid managed care organization contracted with the Medicare Advantage plan that oversees the fully integrated dual eligible special need plan.”

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(Source: Health Payer Intelligence, December 19^th, 2022)