Dual Eligibles – Who are they?

What are Dual Eligibles, and why is everyone talking about them?

Simply put, dual eligibles are individuals who are eligible for both Medicare and Medicaid. These individuals are typically part of an under-served market and are eligible for a year-round SEP based upon their low income status.

Finding Dual Eligibles

As most of you know, Medicare is a federal program with deductibles and cost sharing associated with Parts A, B, and D. Medicaid is a federally funded but state run program. Because the funds come from the federal government, the feds get to tell the states what they MUST cover. The states determine on their own if they WANT to cover additional benefits. An individual who has both Medicare and Medicaid is entitled to have all of their cost sharing for Parts A and B paid for by Medicaid. For beneficiaries of a Part D Benefit, Medicare will automatically enroll them into a Part D plan that has a premium below the regional benchmark.

If a beneficiary has Medicare and has all of their cost sharing paid for by Medicaid, why would a Medicare Advantage plan be a good fit? It is really simple…Dual Eligibles receive EXTRA BENEFITS!!! A D-SNP (Dual Special Needs Plan) typically covers additional benefits such as dental, routine eye exams and eyeglasses. Some D-SNPs include transportation, hearing aids and over-the-counter benefits as well! The downfall to an MA plan is most D-SNP’s are HMO’s with specific doctor networks. The good news is that Medicaid beneficiaries are already accustomed to using Medicaid networks and getting referrals, so the fact that most D-SNP’s are HMO plans is not a detrimental factor in most cases.

Dual Eligibles are Members of Medicare Savings Plans or MSP’s

All states have Medicare Saving Programs (MSP’s) as well. Medicare Savings Plans pay for Part B premiums if you make below a certain income limit. For instance, SLMB’s can make up to 120% of the Federal Poverty Level (FPL) and are guaranteed to get their Part B premium paid for by the state. QI-1’s can make up to 135% of the FPL, but the funds to pay the Part B premiums are first come first served and are NOT guaranteed by the state to be available to pay the Part B premiums. Each state Medicaid sets their own rules and regulations for benefits in that state depending upon income and other factors.

Every year I meet two or three people who do not know about these Medicare Savings Plans, or that they may be eligible to receive Low Income Subsidy (LIS) benefits to reduce their prescription drug costs. Once I sit down with these folks at the kitchen table and help them see real savings, I know I’ve made a meaningful impact in their life!  By spending just a few minutes on this, I can add a lifetime client to my book of business who is more than happy to send friends and family my way.

You can save your client up to $300 a month or more by helping them apply for LIS and other Medicare Savings programs. Most programs do not require them to be full Dual Eligibles. Individuals who make between 100-135% of the Federal Poverty Level (FPL) can apply to have their Medicare Part D premium covered and their prescription cost sharing significantly reduced as well as their Medicare Part B premium covered. Click here for a link to your state’s programs.

Join us on March 14th for the “Finding Dual Eligibles” webinar to learn more!

RB Insurance Group is here to make it happen for you!

Upcoming Training Events:

Prospecting your Book of Business

Medicare cost-sharing

RBI National Sales Manager: Charlie Ferrell

Charlie started his senior insurance career after a brief 30-year stint in the restaurant industry. In the 12 years since then, he has been blazing trails and setting standards for excellence all over! A native son of Utah, he has been a state manager for RBI as well as a managing general agent for UHC, Coventry, Molina and other carriers! Charlie came to RBI as the National Sales Manager in 2015, and is an invaluable resource for our agents and staff for marketing, compliance, and sales topics! Charlie’s field experience with senior insurance sales has made him an expert in our insurance CRM: Medicare Sales Engine. If all of that wasn’t enough, Charlie specializes in the Dual-Eligible market and is leading the charge behind RBI’s new “Dual Eligibles for Newbies” seminars!

Prospecting your Book of Business

Now that the New Year is upon us and our client are using their plans is a great time to go prospecting. Prospecting you say? But AEP ended a month ago! Use your existing book of business to write more business. There are plenty of additional products to sell. From indemnity products to Medicare Supplement plans to Final Expense. Now is the time to start a dialog about who they know that you can help. If you don’t ask your clients for referrals you are leaving business on the table for others to write.

This is also the best time to contact your new and existing clients that are using a new plan. Get in touch with them and let them know that you value their business and help them use their plan to the fullest. It is much easier to nip a small problem right now before it gets out of control; maybe it’s a different co-pay for a drug they have been taking for a while or the fact that they have to use a different doctor since switching plans. Anything you do right now will cement your place in their mind as their trusted advisor.

We’ve found that new members appreciate calls from their agent after the first of the year to check-in and make sure they have no outstanding questions about their plan or benefits. These calls also allow you to strengthen the bond with your members early in their plan year. To help you out, we have a few tips on topics to discuss with members during the first 2 months. By making the call and using these guidelines, you are able to instill your client’s confidence in you and their plan.

  • Ask if they have any questions about their plan/benefits
  • Review doctor network if appropriate. (Medicare Supplements have no network)
  • Review RX coverage, co-payments and pharmacies (including if they travel)
  • Discuss nurse line available 24/7 (most MA plans)
  • Discuss Extra Benefits (where applicable)
  • Discuss Silver Sneakers/Silver Fit where applicable

Most carriers are now also recommending you call your clients at the 60 and 90 day point as well. Topics are the same as listed above but by now they should have had a chance to use their benefits. If they have not used their benefits, remind them of the OTC benefit (if the plan has one) and how to order their items, especially if the benefit is a monthly or quarterly benefit and if it is a “Use it or lose it” type of benefit.

During your close is the best time to ask for referrals. You can ask for names and addresses but not phone numbers for MA clients. Remind them of the fact that you are not allowed to call their friends if they need help but that their friend has to call YOU in order to be compliant (for MA/PDP referrals). This also reminds them that anyone who calls them may not be following CMS guidelines and further insulates them as your client.

I don’t know about you, but whenever I meet with someone new I always ask them if they’ve worked with an agent in the past and the most common answer I hear is, “yeah, but I haven’t heard from in the past year or two.” The goal of your follow-ups is to not be that agent! The more you stay in front of your clients and help them use their plan, the more business you’ll see stay on the books.

Want even more tips on how to generate more referrals? Give us a call at 1-800-997-3107 and Learn how RBI Works for You. Looking for year-round sales opportunities? Fill out this contract request form, or call our office today to learn more!



Medicare cost-sharing
USA Senior Care Network
2019 AHIP
AEP