HMO SNP or Dual Eligible Medicaid/Medicare Plans (What are the Benefits?)

Dual Eligible Medicaid/Medicare Plans, or HMO Special Needs Plans (SNPs), vary widely across the United States and among various insurance providers, but typically have many commonalities, including low or zero-cost monthly premiums and deductibles for eligible members. The vast majority of SNPs also offer additional benefits that go above and beyond traditional insurance benefits, such as alternative medicine coverage, fitness programs, and in-home care. Humana is one insurance provider seeking to effect paradigm shifts by focusing on “whole person” health care and increased transparency in its brand messaging.

Anthem Blue Cross and Blue Shield HMO SNP Overview

  • Anthem Blue Cross and Blue Shield offers an Anthem MediBlue Dual Advantage HMO SNP plan for eligible Medicare and Medicaid beneficiaries. To be considered eligible for the MediBlue Dual Advantage plan, members must be entitled to Medicare Part A, enrolled in their state’s Medicare Part B and Medicaid programs, and reside within Anthem’s service coverage areas.
  • Monthly premiums for MediBlue Dual Advantage vary by state, and while plans do not have deductibles for medical care, certain states do implement deductibles for Medicare Part D prescription drugs. Yearly out-of-pocket expense limits for members are typically less than $6,700 for in-network facilities and physicians.
  • Though certain states charge up to 20% coinsurance fees or small deductible, the majority of policy holders incur a $0 copay for inpatient and outpatient hospital visits, in-network primary and specialist doctor visits, annual physical exams, preventive care services, emergency and urgent care services, and diagnostic and lab services.
  • Hearing services are largely covered by Anthem with a $0 copay, though some states do charge up to 20% coinsurance. MediBlue Dual Advantage covers a routine hearing screening and hearing aid evaluation each year as well as charging $0 copay for hearing aids up to specified maximum benefit amounts.
  • Dental services are covered at a $0 copay for most plan members, but certain states may charge up to 20% coinsurance. The MediBlue Dual Advantage plan covers two oral exams, two cleanings, one x-ray, and one fluoride treatments each year from in-network dentists. Yearly allowance for comprehensive dental services varies by state.
  • Vision services are covered at no cost for the majority of MediBlue Dual Advantage members, though some states charge members up to 20% in coinsurance. The Dual Advantage plan covers members’ annual eye exams at $0 copay and provides yearly coverage amounts, which vary by state, for prescription glasses and contact lenses.
  • MediBlue Dual Advantage plans largely cover inpatient and outpatient mental health service visits at no cost, but certain states charge a “Medicare-defined cost share“. The plan covers a lifetime limit of 190 days of inpatient mental health care at psychiatric hospitals and includes 60 extra “lifetime reserve days“.

Anthem Blue Cross and Blue Shield HMO SNP Additonal Plan Benefits

  • Anthem’s MediBlue Dual Advantage plan covers up to 100 days at a Skilled Nursing Facility (SNF). Coverage is largely at no cost to members, though some states charge “Medicare-defined cost share” fees.
  • MediBlue Dual Advantage covers most ground, water, and air ambulance transportation at no cost to members, though certain states charge up to 20% coinsurance. This plan also offers coverage of routine transportation services to a limited number of plan-approved locations within 60 miles of members’ residences.
  • Medicare Part B drugs and chemotherapy drugs are generally covered for members at $0 copay, with certain states charging up to 20% coinsurance.
  • Anthem’s Dual Advantage plan allows members to select specialized add-on benefits called Essential Extras to their plans at no additional cost. Extras include goods and services such as personal home helpers, assistive devices, home food deliveries, service animal support, and pest control services.
  • The Dual Advantage plan also features $0 copays or small coinsurance payments for a wide variety of additional benefit services, such as acupuncture, chiropractic care, podiatry services, home health care and telemedicine services, durable medical equipment and supplies, outpatient rehab and renal dialysis.
  • MediBlue Dual Advantage covers up to $50 each quarter for certain pre-approved over-the-counter (OTC) drugs and health supplies for members. Unused OTC credits roll over from quarter to quarter but not from year to year.
  • Anthem offers a SilverSneakers fitness program to members at no cost. The SilverSneakers program includes on-demand home video workout classes, access to amenities at participating locations, group activities, and a web-based members-only community. Members also have access to 24/7 NurseLine, a 24-hour hot line for basic healthcare advice.

Signature Advantage HMO SNP Overview

  • Signature Advantage offers its Signature Advantage Community plan for members eligible for both Medicare and Medicaid. The plan features low monthly premiums that vary by state, such as $29.50 per month in Kentucky, and requires members to continue paying Medicare Part B premiums. The plan generally offers low deductibles and a $5,500 annual out-of-pocket cost maximum, which does not include prescription drugs.
  • Members of the Community plan pay $295 each day for the first week of inpatient hospital stays, followed by $0 copays for days 8 through 90 of their stays. Up to 60 additional “lifetime reserve days” are offered for inpatient hospital stays at a coinsurance cost of $670 per reserve day. Outpatient hospital visits are covered at a cost of $300 to members per visit for Medicare-covered services.
  • Community plan holders pay $20 per visit to Medicare-covered primary care physicians and $35 per visit to approved specialists. Members incur a $0 copay for Nurse Practitioner services at assisted living facilities, home health services, and preventive care services such as vaccines and diabetic screenings.
  • Members of Signature Advantage’s plan pay 20% of emergency care costs up to $90 and $45 per visit for urgent care services. Diagnostic, lab, and x-ray services are also covered after a $100-$200 payment for Medicare-covered services and procedures.
  • Medicare-covered hearing services are covered after a $35 copay, and members incur no charge for routine annual screenings or hearing aid evaluations. Up to $950 worth of credit for hearing aids for both ears combined is provided to members every two years.
  • Members pay 20% of cost for medicare-covered dental services. Signature Advantage Community covers up to $750 in preventive dental services each year and features $0 copays for oral exams, cleanings, and dental x-rays.
  • Community plan members pay $35 for vision services. The plan covers one routine annual eye exam per year as well as up to $150 in credit toward prescription eyeglasses or contact lenses. Mental health services are also covered at a $35 copay for outpatient group or individual therapy visits.

Signature Advantage HMO SNP Additional Plan Benefits

  • Signature Advantage Community covers 30 days of care at an SNF for members at no cost. Members pay $160 each day for days 31 to 100 of their SNF stays and are responsible for all costs after day 101. Signature Advantage requires prior authorization for SNF coverage, but does not require previous hospital stays.
  • Members pay 20% of costs for Medicare-approved rehabilitative services, such as occupational therapy, physical therapy, and speech therapy.
  • Community plan members pay $275 for each instance of Medicare-covered ambulance transportation services. General routine transportation is not covered for members under Signature Advantage’s Community plan.
  • Podiatry services are covered for Community plan members after a $35 copay. Members pay nothing for up to six “non-covered routine podiatry services” each year.
  • Members pay 20% of cost for Medicare-covered medical equipment and supplies, such as durable medical equipment (DME), prosthetics, and diabetic supplies. Signature Advantage requires prior authorization for medical equipment costs exceeding $250.
  • Signature Advantage covers Medicare Part B drugs after a 20% coinsurance payments for Medicare-covered prescriptions. Signature Advantage requires prior authorization for prescription costs exceeding $250 and may subject members to “step therapy”.

UnitedHealthcare HMO SNP Overview

  • United Healthcare offers UnitedHealthcare Dual Complete HMO SNP to members entitled to benefits from both Medicare and Medicaid plans. To be considered eligible, individuals must be eligible for Medicare Part A, enrolled in Medicare Part B, and reside within UnitedHealthcare’s services areas in the United States.
  • Monthly plan premiums, annual medical deductibles and maximum out-of-pocket payment amounts for medical services through UnitedHealthcare Dual Complete are generally low but vary by state.
  • Dual Complete plan holders generally incur a $0 copay for inpatient and outpatient hospital stays, though certain states may charge members up to 20% coinsurance. Inpatient hospital stays are subject to a $1,408 deductible for the first 60 days, $352 copays per day for days 61–90, and $0 copays for an unlimited number of days from day 91 onward.
  • Primary, specialist, or virtual medical visits are covered at a $0 copay, though some states charge up to 20% coinsurance. Members incur no charges for Medicare-covered preventive care and one yearly routine physical.
  • Dual Complete members pay $0-$90 copays for emergency and urgent care visits. Members admitted to hospitals within 24 hours of their initial visits incur inpatient hospital copays rather than emergency visit copays. Diagnostic, lab, and x-ray services are generally covered at no charge, though certain states charge members up to 20% coinsurance.
  • UnitedHealthcare Dual Complete generally covers the cost of hearing services for members at no charge, but some states charge up to 20% coinsurance. Annual hearing screenings are covered at no cost, and approximately $2,000, depending on state, of yearly credit for hearing aids is provided to members for up to two hearing aids every 2 years.
  • Dental services, including preventive exams, cleanings, x-rays and fluoride treatments, are covered at no charge for members. Vision services are also generally covered at $0 copay, though certain states charge members up to 20% in coinsurance fees. Members pay $0 for eyewear after cataract surgery, annual vision screening, and receive up to $200 credit every two years for prescription glasses, frames, or contacts.
  • Plan members generally have a $0 copay for mental health services, including outpatient group and individual therapy sessions. Inpatient mental health visits are fully covered for the first 90 days, and then are subject to a $1,408 deductible for the first 60 days, $352 copays per day for days 61–90, and $704 copays per day for days 91–150.

UnitedHealthcare HMO SNP Additional Plan Benefits

  • Skilled Nursing Facility visits are covered for Dual Complete members for up to 100 days. Plan holders incur a $0 copay per day for their first 20 days and a $176 copay per day for days 21–100. Physical and speech therapies are also generally fully covered, though some states charge up to 20% coinsurance.
  • Dual Complete plan members incur a small copay or coinsurance payment for most ground or air ambulance transportation services. Routine transportation, however, is fully covered for a limited number of one-way trips each year to or from approved locations.
  • Medicare Part B drugs and chemotherapy drugs are subject to either a $0 copay or up to 20% coinsurance payment, depending on members’ state of residence.
  • Additional benefits available to members at no charge or up to 20% coinsurance payment include chiropractic care, acupuncture, diabetes management supplies and training, durable medical equipment, podiatry services, meal benefits, home health care, hospice care, occupational therapy, opioid and outpatient substance abuse treatment services, and renal dialysis.
  • UnitedHealthcare offers Dual Complete members access to a fitness program through Renew Active. Membership includes standard access at participating fitness locations, group fitness classes, online mental health exercises, and an in-person fitness evaluation.
  • Dual Complete members also have access to NurseLine, a 24/7 hot line connecting patients with registered nurses, and a Personal Emergency Response System (PERS). Members taking advantage of PERS have access to in-home monitoring systems that can automatically detect falls or allow members to summon assistance with lightweight wearable buttons.

WellCare HMO SNP Overview

  • Though offerings vary by state, WellCare generally offers WellCare Access and WellCare Liberty HMO SNP plans to eligible members in the United States. Eligible members are entitled to both Medicare and Medicaid benefits, and plans cover all Medicare Part A and Part B services as well as prescription medications.
  • Access and Liberty plan members generally pay $0 in monthly premiums, though policy holders are required to continue paying any Medicare Part B premiums. WellCare’s medical care deductible is $0 for in-network services, and maximum member responsibilities for out-of-pocket expenses range from $3,400 to $6,700 annually, depending on state of residence.
  • Inpatient hospital visits are fully covered for up to 90 days. Outpatient visits and external observation services are covered at no cost to members for both surgical and non-surgical services.
  • WellCare members incur no costs for in-network primary and specialist doctor visits, and also pay nothing for in-network preventive care services. Emergency and urgent care services incur a $0 copay for in-network visits, and emergency and urgent care fees are waived for members admitted to hospitals within 24 hours. In-network lab, diagnostic, and x-ray services are also available to members at no cost.
  • Access and Liberty plans charge $0 copays for in-network hearing exams, annual routine screenings, and hearing aid evaluations. Members receive an annual hearing aid allowance of $2,000-$3,000, depending on plan and state of residence, for up to 2 hearing aids per year.
  • Dental services are available to members at no charge for comprehensive care or in-network preventive care. Plan members receive one dental cleaning every 6 months, one dental x-ray every 12 to 36 months, preventive oral exams once every 6 months, and fluoride treatments once per year at no charge.
  • Plan members incur $0 copay for “Medicare-covered diabetes retinopathy screening and all other Medicare-covered eye exams”, including routine annual eye exams and glaucoma screenings. Plans also offer $0 copays for Medicare-covered eyewear, which can include up to $300 worth of credit toward contacts or glasses per year.
  • WellCare members pay $0 copays for up to 90 days of inpatient treatment for mental health. Plans cover up to 190 lifetime days of inpatient mental health treatment at psychiatric hospitals, and outpatient group and individual therapy sessions are provided at no cost.

WellCare HMO SNP Additional Plan Benefits

  • Members of WellCare Access or Liberty plans are offered stays of up to 100 days per benefit period at Skilled Nursing Facilities. In-network physical and occupational therapy services are also offered at no-charge.
  • Plan members incur $0 copays for ground or air ambulance transportation. Up to 60 one-way routine transportation trips to plan-approved healthcare providers are also provided to members each year at no cost.
  • Medicare Part B drug prescriptions are offered to plan members at a $0 copay.
  • Additional benefits available to members at no charge include chiropractic care, home health care, hospice care, outpatient substance abuse therapy, renal dialysis, post-acute and chronic meals, durable medical equipment, diabetic supplies and training, podiatry services, six in-home support services visits per year, and $200 OTC health product credits per quarter.
  • WellCare plan members are offered annual membership to a WellCare proprietary fitness program at no charge. Members receive yearly access to participating health centers, home exercise programs, and Fitbit fitness trackers. Members also have the option to participate in WellCare’s PERS or contact a 24-hour Nurse Advice Line for assistance.

Humana Medicare Plan Improvement Strategies

  • Humana has served Medicare plan beneficiaries for over 30 years, with more than 8,400,000 Medicare plan members across the United States as of mid-2019. Over 4,000,000 of those members have enrolled in a Medicare Advantage plan for additional coverage, prescription drug payment assistance, and extra benefits such as dental, hearing, and vision services.
  • The Centers for Medicare and Medicaid Services (CMS) rated approximately 92% of Humana’s Medicare Advantage member contracts as 4-stars or above for 2020. More than 99% of retired members of Humana’s Group Medicare Advantage plans enjoyed 4-star or above contracts for the year.
  • In 2017, shortly after announcing the termination of its planned merger with Aetna, Humana announced a multi-part improvement strategy for its plan offerings. Company press releases set forth commitments to improve Humana’s focus on individuals suffering from chronic conditions, especially existing and future members of Medicare Advantage and dual eligibility plans. To advance these offerings, Humana pledged to maintain its focus on employer group customers, develop new relationships with “Medicare age-ins“, and leverage existing partnerships with healthcare professionals.
  • Humana also vowed to augment its integrated care offerings for members by increasing its number of partnerships with primary care services and clinics, enhancing its complementary home and local pharmacy services, and investing in integrated healthcare technology solutions. In doing so, Humana hopes to “eliminate friction points” and make accessing care more transparent and convenient for plan members.
  • In 2018, Humana announced modifications to Medicare plans with a specific focus on value and affordability. 2018 Medicare plans featured increased plan choices in more locations around the US, more plans providing access to fitness services, a Wal-Mart prescription savings plan, more plans with low or no monthly premiums, and increased cost-sharing options for prescriptions and primary care visits.
  • Humana’s 2020 Medicare Advantage plans were designed to offer “ways to care for the whole person” and additional convenience for plan members. Most Medicare Advantage plans for 2020 deliver coverage for dental, hearing, and vision services as well as fitness memberships, home meal deliveries following inpatient hospital visits, and yearly allowances for OTC personal care products.
  • Other features of Humana’s 2020 Medicare plans include in-home services and support for caregivers, transportation to routine medical appointments or fitness centers, and expanded Special Needs Plans offered across 28 states. Humana also began offering Humana Honor, a new Medicare Advantage plan designed specifically for military veterans.
  • A 2020 press release from Humana describes the company’s current focus as the “social determinants of health“. Humana aims to assist members by stabilizing monthly premium costs while addressing environmental and demographic obstacles to general well-being, such as food insecurity and availability of transportation.

Humana Brand Messaging Insights

  • Humana’s Chief Consumer Officer, Jody Bilney, refers to healthcare services as a “fantastic challenge for marketers“. Ms. Bilney makes note of traditional issues plaguing healthcare companies’ attempts to communicate with customers, particularly the use of industry jargon such as “drug formulary” rather than simple phrases such as “list of drugs”.
  • Ms. Bilney also points out the heavily-regulated nature of marketing in the healthcare industry, which requires approximately 400,000,000 pieces of mail, often with lengthy and difficult-to-understand messages, to be sent to members by law each year. Humana eventually recognized that this “transactional” type of communication, when seen through customers eyes, posed significant marketing challenges and committed to improving its messaging.
  • Humana’s current marketing focus is to promote the “benefits of good health” and inspire its customers to live more healthfully “on their terms”. Bilney notes that definitions of good health vary among different segments of the population, with the 75% of Humana’s customers aged 65 and older more likely to define good health as simply not being actively unhealthy.
  • Humana is making strides to not only address measurable health outcomes, such as blood pressure, but to help customers who define good health as the ability to take care of “daily routines independently“. By talking about the importance of attending grandchildren’s plays or running errands rather than focusing on A1C levels, Humana is addressing the crucial reasons behind their customers’ quests for healthy living.
  • Since 2015, when Humana partnered with advertising firm BBDO, the company has maintained a strong focus on digital marketing. Digital Enterprise VP Jeff Reid expressed the company’s digital marketing strategy simply as “Know me, show me you care, make it easy, and help me.”
  • While traditional healthcare insurance marketing content tends to focus on dry details about premiums and claims, Humana is making efforts to broaden their approach with content touching on everyday health and wellness topics. The Humana website features an entire health management section with easy-to-navigate wellness articles, and Humana’s general marketing messages attempt to communicate that “they care about more than just dollars and [cents]“.
  • Humana is also making strides to foster community engagement, especially on social media. An active Twitter account frequently shares video blogs, customer-generated content, and wellness tips and also provides general customer support via the @HumanaHelp Twitter handle.
  • Another focus of Humana is the simplification of navigating insurance plan information for customers. For example, while Humana previously hosted over 50 different websites for each business within its umbrella, the company recently made the decision to shrink all of its offerings down to a single site. Humana’s new interface is much more simple and user-friendly, making site visits much less frustrating for visitors.
  • In 2017, Humana partnered with marketing firm Persado to develop an email marketing campaign to increase engagement for one-click prescription refills. Persado’s AI marketing capabilities allowed Humana to customize subject lines, email bodies, and calls to action based on messages “most likely to engage readers’ emotions” for their one-click refill marketing efforts.
  • Persado’s emotional focus for Humana’s marketing effected a drastic increase in results when compared to baseline outcomes. Humana’s one-click refill marketing experiment realized a 22.8% increase in message open rates and a 73% increase in click rates.
Glenn is the Lead Operations Research Analyst at The Digital Momentum with experience in research, statistical data analysis and interview techniques. A holder of degree in Economics. A true specialist in quantitative and qualitative research.

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