For skilled nursing facilities, dual-eligible residents in less-integrated MA plans may face weaker Medicare-Medicaid coordination, creating friction in authorization, discharge planning, and payment. As D-SNP enrollment grows and CMS tightens integration requirements, SNFs should understand which plan types their dual-eligible residents hold and how varying levels of Medicaid integration affect operations and revenue.
Patient-Reported Characteristics Across Dual-Eligible Medicare Advantage Plan Types
This cross-sectional study including 147,923 dual-eligible beneficiaries found differences in the characteristics of full-benefit dual-eligible beneficiaries across MA plan types. Older dual-eligible individuals and those with multiple functional limitations were more likely and those in highly socioeconomically disadvantaged neighborhoods were less likely to enroll in fully integrated dual-eligible Special Needs Plans compared with less integrated plan types. In this cross-sectional study of full-benefit dual-eligible beneficiaries, substantial health burdens were reported, with notable differences across plan types. These findings highlight the need for tailored interventions to improve care and further research to understand MA plan selection in this population.
— JAMA Network Open, April 18, 2025
Offiaeli, Kendra, et al. “Patient-Reported Characteristics Across Dual-Eligible Medicare Advantage Plan Types.” JAMA Network Open, 18 Apr. 2025. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2832973.
Medicare Advantage Study Shows Enrollment Gaps Among Vulnerable Dual-Eligible Seniors
Researchers found that Fully Integrated Dual-Eligible Special Needs Plans (FIDE-SNPs) — the most comprehensive integrated plans — tended to enroll more vulnerable seniors. These plans had higher proportions of beneficiaries aged 85 and older (59%) and those living with caregivers (56.6%) compared to less integrated plan types. FIDE-SNP enrollees also reported more comorbidities and greater difficulties with daily activities than those in other MA options..
— McKnight’s Long-Term Care News, April 19, 2025
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