Rov qab mus rau Medicare Advantage Options rau Dual Tsim Nyog tau txais txiaj ntsig​​ 

D-SNP “look-alike” plans are Medicare Advantage (MA) plans that are marketed to, and have membership consisting of at least 60 percent dual eligible beneficiaries. However, unlike true D-SNPs, D-SNP look-alike plans do not provide care coordination and wrap-around services. Starting in 2025 the threshold for determining a D-SNP look-alike plan was lowered from 80 percent to 70 percent and will be reduced to 60 percent in 2026. These plans often have marketing names that sound like D-SNPs, using the terms “coordinated” or “dual.” Look-alike plans may be unattractive to non-dual eligible beneficiaries because they often have higher cost-sharing requirements – which only dual eligible beneficiaries are not required to pay.​​ 

Vim tias cov phiaj xwm zoo sib xws yog tsom rau cov tib neeg tsim nyog tau txais txiaj ntsig tab sis tsis raug rau kev sib koom ua ke uas tau txais txiaj ntsig zoo dua, tsoomfwv Lub Chaw Pabcuam Medicare & Medicaid (CMS) tau tshaj tawm cov cai hauv xyoo 2020 uas xav kom MA cov koom haum txiav tawm D-SNP daim ntawv cog lus zoo sib xws rau lub Ib Hlis 1, 2023.  Tsis tas li ntawd, CMS tau tshaj tawm cov cai hauv xyoo 2024 uas ua rau cov phiaj xwm MA ntxiv tau raug cais raws li cov phiaj xwm zoo sib xws, thiab xav kom MA cov koom haum txiav txim siab ntxiv D-SNP daim ntawv cog lus zoo sib xws pib txij lub Ib Hlis 1, 2025. 2020 thiab 2024 tsoom fwv cov kev cai tseem muab kev xaiv rau cov MA cov koom haum hloov pauv lawv cov tswv cuab zoo ib yam mus rau lwm lub MA cov phiaj xwm muab los ntawm tib lub koom haum, xws li D-SNPs tiag tiag lossis cov phiaj xwm MA ib txwm muaj nrog $ 0 tus nqi. MA cov phiaj xwm yuav ua haujlwm nrog CMS los siv cov tswv cuab hloov pauv uas yuav tsum tau ua raws. Cov ntaub ntawv tsis ntev los no thiab kev taw qhia los ntawm CMS rau MA cov koom haum ntawm kev hloov pauv no tuaj yeem nrhiav pom ntawm CMS.gov lub vev xaib. Cov ntaub ntawv tshwj xeeb ntxiv txog kev hloov pauv 2023 nyob ntawm no. Qhov kev hloov pauv no yog tsim los muab kev saib xyuas txuas ntxiv thiab kev tiv thaiv tus nqi sib koom rau ob tus neeg tau txais txiaj ntsig, nrog rau muab kev saib xyuas zoo dua rau cov tib neeg tam sim no rau npe rau hauv txoj kev npaj zoo ib yam.​​ 

MA cov koom haum nrog cov phiaj xwm zoo sib xws yuav tsum xa cov ntawv ceeb toom thaum lub caij nplooj zeeg rau lawv cov tswv cuab nrog cov ntaub ntawv hais txog kev hloov pauv txoj kev npaj. Cov kev taw qhia dhau los ntawm CMS rau MA lub koom haum ntawm kev hloov pauv no tuaj yeem pom ntawm DHCS lub vev xaib. 

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