PremiumAssist Dual Eligibility Outreach and Retention Services
- The most experienced company for screening and dual-enrolling Medicare Advantage plan members.
- Systematic re-determination/re-enrollment to ensure uninterrupted value.
What We Do
PremiumAssist Dual Eligibility Outreach and Retention Services are a key subset of the Human Arc family of Medicaid Special Status Enhancement Services. Our outreach and retention services focus on important aspects of assistance to Medicare Advantage members and plans alike:
- Informing Medicare Advantage health plan members of potential eligibility for Medicare Savings Programs that can pay their monthly Medicare Part B premiums for them.
- Screening and assisting members with the completion and filing of applications to determine initial eligibility and thereafter each year to ensure continued enrollment.
- Enrolled members provide a significantly higher monthly capitation to the Medicare Advantage plan from Centers for Medicare and Medicaid Services (CMS).
Why Outreach to Dual Eligible People is Important
According to the Henry J. Kaiser Family Foundation, 40 percent of the approximately 37 million Medicare beneficiaries have incomes at or below 200 percent of the federal poverty level (FPL). Only 17 percent, however (some 6+ million low-income elderly and disabled), are currently dual eligible, enrolled in both Medicare and Medicaid. This suggests that a significant portion of the over-30 million other Medicare-enrolled citizens in our country is eligible for a Medicare Savings Program but not yet enrolled
Research conducted by America's Health Insurance Plans (AHIP) indicates that among a significant regional sampling of unsubsidized Medicare beneficiaries who had supplemental coverage and incomes below the poverty level, 76 percent had selected Medicare Advantage plans. With the increased capitation inherent with dual eligibility, this represents a very significant opportunity for Medicare Advantage health plans to enhance their revenues while maximizing incomes among those plan members who most need that assistance.
Why Re-determination Services Are Relevant
Very few states have simple Medicaid re-determination processes. In most states, the Medicare beneficiaries must re-initiate the complete application, documentation and interview process he or she went through at the time of initial enrollment, according to Marilyn Ellwood, The Medicaid Eligibility Maze, Coverage Expands but Enrollment Problems Persist, The Urban Institute, 12/99,
Perhaps because of these requirements, many enrollees drop out of the Medicaid program even though they may still qualify. It is not clear whether these dropouts understand that they could continue to be eligible or whether they consider the value of Medicaid benefits not worth the effort involved with the enrollment process. Continuity in Medicaid enrollment has not been a Medicaid priority.
So it's not a surprise that the annual re-enrollment causes anxiety and confusion for Medicare Savings Program enrollees.
Major Benefits
- Increase in member discretionary income - with members receiving $96.40 more per month in their Social Security checks. (2008 and 2009 rate)
- Increase in plan income - with much higher capitation to the Medicare Advantage health plan for dual-eligible members.
- Expanded customer loyalty - with a membership that knows its plan is looking out for its interests.
The Human Arc Edge
PremiumAssist Dual Eligibility Outreach and Retention Services deliver an unmatched array of advantages:
- Experience - Human Arc has well over two decades of experience with eligibility and enrollment services. Human Arc's proven communications and skilled enrollment professionals are highly successful in addressing the members' questions, concerns and needs.
- Successful Relationship with CMS - Human Arc has many years of experience working successfully with CMS, which reviews and approves all communication associated with the outreach and re-determination initiatives. Our customized template provided to the Medicare Advantage plan upon execution of a contract meets all requirements of CMS' Medicare Managed Care Manual and allows an efficient and expedited timeframe for approval.
- Proven Results - Our expanded, demographic-sensitive outreach communications maximize the response rate from plan membership and ensure their continued cooperation when it is time to re-apply for the programs.
- Maximum Rewards -Our clients commonly experience initial eligibility conversions up to an additional 5% of their active membership, while over 94% of members initially assisted are re-enrolled after the initial year. And 100% contingency fee-based compensation assures there are no surprises.
- Complete Plan-Friendliness - The minimum of impact on day-to-day health plan operations means no interruptions or costly learning curves. Human Arc's proven implementation with new clients ensures that the outreach services do not interfere with other important Medicare Advantage plan strategic initiatives. And the retention service requires zero investment in time, equipment, or personnel to maintain the ongoing revenue opportunity to the plan.
- Member Sensitivity - Our outreach and retention services are characterized by deep experience with special populations, an accent on dignity, 100% HIPAA compliance and a genuine sensitivity to personal privacy. We offer convenient communication options for reaching our specialists plus personalized application completion and filing
- Guaranteed Follow-through - PremiumAssist Dual Eligibility Outreach Services minimize potential errors by monitoring the CMS Monthly Membership Reports (MMRs) following enrollment to verify that successfully enrolled members are bought in to the Medicare Part B premium assistance benefit. This obviates many potential disconnects between government agencies at various levels that could otherwise result in delays in paying Medicare Part B premiums for members and higher dual eligible capitation to health plans.
Medicaid Special Status Enhancement Services Case Studies
Nothing speaks like proof, so here's how these services have helped clients.