Dual-Eligible Beneficiaries: Selling D-SNP Plans Through Your Call Center
Dual-eligible beneficiaries—individuals who qualify for both Medicare and Medicaid—represent one of the fastest-growing and most underserved segments in Medicare. With over 12.5 million dual-eligible Americans and D-SNP (Dual Eligible Special Needs Plan) enrollment growing by double digits annually, this market is too large and too lucrative for call centers to ignore. But selling D-SNP plans requires a different approach than standard Medicare Advantage. The beneficiary population has unique needs, the compliance requirements add additional layers, and the sales conversation demands sensitivity and specialization. This guide covers everything your call center needs to successfully identify, route, and enroll dual-eligible beneficiaries in D-SNP plans.
What Does "Dual-Eligible" Mean?
A dual-eligible beneficiary qualifies for both Medicare (typically due to age 65+ or disability) and Medicaid (due to low income and limited assets). These individuals are among the most vulnerable populations in healthcare—they tend to be sicker, have more chronic conditions, and face greater barriers to accessing care than the general Medicare population.
Dual-Eligible Categories
Full Dual-Eligible (FDE)
Qualifies for full Medicaid benefits in addition to Medicare. Medicaid covers Medicare premiums, deductibles, and copays. These beneficiaries have the most to gain from D-SNP plans that coordinate both programs.
Partial Dual-Eligible (PDE)
Qualifies for limited Medicaid assistance—typically help with Medicare premiums (QMB, SLMB, QI programs) but not full Medicaid benefits. Some D-SNP plans accept partial duals; eligibility varies by plan and state.
QMB (Qualified Medicare Beneficiary)
Medicaid pays Medicare Part A and B premiums, deductibles, copays, and coinsurance. Income at or below 100% FPL. QMB is the most common partial dual category and is eligible for most D-SNP plans.
SLMB (Specified Low-Income Medicare Beneficiary)
Medicaid pays only the Part B premium. Income between 100–120% FPL. SLMB eligibility for D-SNP varies by state and plan—always verify before discussing enrollment.
D-SNP Plans: What Makes Them Different
D-SNP (Dual Eligible Special Needs Plans) are a category of Medicare Advantage plans specifically designed for dual-eligible beneficiaries. They combine Medicare and Medicaid benefits into a single, coordinated plan—simplifying what is otherwise a confusing and fragmented healthcare experience for the beneficiary.
Key D-SNP Benefits for Beneficiaries
$0 or Low Premiums
Most D-SNP plans have $0 monthly premiums and $0 copays for primary care, making them extremely attractive to low-income beneficiaries.
Coordinated Benefits
One plan, one card, one phone number for both Medicare and Medicaid benefits. Eliminates the confusion of managing two separate programs.
Extra Benefits
D-SNP plans often include supplemental benefits not available in standard MA: transportation to appointments, OTC allowances, meal delivery, and in-home support services.
Care Coordination
Dedicated care coordinators help beneficiaries navigate complex health needs, schedule appointments, and connect with community resources—a critical service for this population.
Identifying Dual-Eligible Beneficiaries in Your Call Flow
Not every caller who contacts your center is dual-eligible, and not every dual-eligible beneficiary knows they qualify for a D-SNP plan. Your call flow needs systematic screening to identify potential D-SNP candidates. Understanding Special Enrollment Period opportunities is critical here, since dual-eligible beneficiaries have unique SEP rights.
Screening Questions for Dual Eligibility
The direct question. Many beneficiaries know they have both programs. If yes, they're a D-SNP candidate. If unsure, proceed to the next questions.
Some beneficiaries don't realize their state assistance is Medicaid. They may describe it as "the state program" or by the state-specific Medicaid name (e.g., Medi-Cal in California, MassHealth in Massachusetts).
Beneficiaries receiving LIS/Extra Help are often dual-eligible or close to the income threshold. This is a strong indicator that they may qualify for a D-SNP plan.
A concrete question that helps beneficiaries who don't know the term "Medicaid." If they carry a second card from their state's Medicaid program, they're likely dual-eligible.
D-SNP Call Routing Strategies
D-SNP calls should be routed to agents who are specifically trained on dual-eligible populations and the D-SNP plans available in the beneficiary's state. Generic routing to any available agent wastes the opportunity and risks compliance issues. For broader routing strategies, see our call routing strategies guide.
IVR Pre-Screening
Add a D-SNP screening question to your IVR: "If you currently have both Medicare and Medicaid, press 2." This routes potential D-SNP candidates to your specialized team before they even reach an agent.
Dedicated D-SNP Queue
Create a separate queue for D-SNP calls staffed by agents who are trained on dual-eligible needs, appointed with D-SNP carriers, and licensed in the caller's state. Don't mix D-SNP with general MA calls.
Mid-Call Transfer
When a general agent identifies a dual-eligible beneficiary through screening questions, warm-transfer them to the D-SNP team with context. Don't make the beneficiary repeat their information.
State-Based Routing
D-SNP plans are state-specific because Medicaid is a state program. Route based on the beneficiary's state of residence to agents who know that state's D-SNP options, Medicaid rules, and eligibility thresholds.
D-SNP Compliance Considerations
D-SNP sales carry all the standard Medicare compliance requirements plus additional considerations specific to the dual-eligible population. Agents need to be aware of these extra layers. See our Medicare compliance guide for the baseline requirements that apply to all Medicare sales.
Critical D-SNP Compliance Rules
- Eligibility verification is mandatory: You must verify the beneficiary's dual-eligible status before enrolling them in a D-SNP plan. Enrolling a non-dual-eligible beneficiary is a compliance violation that will be caught and penalized.
- State Medicaid agency coordination: D-SNP plans must have a contract (MIPPA agreement) with the state Medicaid agency. Agents must understand which D-SNP plans are available in which states—not all carriers offer D-SNP in all states.
- SOA still required: Even though dual-eligible beneficiaries have year-round enrollment rights, a Scope of Appointment must still be collected before any sales discussion. The SOA must specifically list D-SNP as a product to be discussed.
- No high-pressure tactics: This population is particularly vulnerable to high-pressure sales. CMS scrutinizes D-SNP enrollment practices more closely. Ensure your approach is educational and patient, not aggressive.
- Medicaid loss reporting: If a D-SNP enrollee loses Medicaid eligibility, the plan must be notified within specific timeframes. Agents should educate beneficiaries about the importance of maintaining their Medicaid status.
The D-SNP Sales Approach: Education Over Persuasion
Selling D-SNP plans requires a fundamentally different approach than selling standard Medicare Advantage. These beneficiaries are often confused about their benefits, overwhelmed by the healthcare system, and wary of changes to their coverage. Your agents need to lead with empathy and education.
D-SNP Sales Best Practices
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Start with their current situation
Ask about their current coverage, what they're happy with, and what challenges they face. Many dual-eligible beneficiaries don't realize they're paying for things a D-SNP plan would cover at $0.
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Explain the coordination benefit simply
"Instead of managing two separate programs with two different cards and two different phone numbers, a D-SNP plan puts everything together in one plan with one card." Simplicity is the primary value proposition.
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Highlight the extra benefits
Transportation to doctor's appointments, OTC allowances, meal delivery after hospitalization, dental and vision—these benefits address real daily needs that resonate strongly with low-income beneficiaries.
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Address the fear of losing Medicaid
A common objection: "Will this affect my Medicaid?" Clearly explain that enrolling in a D-SNP plan does not change their Medicaid eligibility. They keep their Medicaid benefits—the D-SNP coordinates them.
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Use plain language—no jargon
Avoid terms like "capitation," "formulary," "cost-sharing," and "network adequacy." Use everyday language: "the doctors you can see," "how much you pay for medicine," "what the plan covers."
The D-SNP Market Opportunity
The D-SNP market is expanding rapidly, driven by demographic trends, regulatory support, and carrier investment. Agencies that build D-SNP capabilities now are positioning themselves for significant growth.
Dual-eligible Americans, representing ~20% of Medicare beneficiaries but ~35% of Medicare spending
Year-over-year D-SNP enrollment growth as carriers expand their D-SNP offerings into new markets
Dual-eligible beneficiaries can enroll in D-SNP plans every month—no waiting for AEP. Revenue opportunity extends beyond enrollment season.
D-SNP commissions are typically equal to or higher than standard MA commissions due to higher plan premiums paid by CMS
Year-Round Enrollment: Your Counter-Seasonal Revenue Stream
Unlike standard Medicare Advantage where enrollment is concentrated in AEP and OEP, dual-eligible beneficiaries can enroll in or switch D-SNP plans every month of the year. This makes D-SNP a critical revenue stream for smoothing out the seasonal enrollment cycle. When your AEP rush ends in December, your D-SNP pipeline keeps producing year-round.
Conclusion: D-SNP Is the Growth Opportunity You Can't Afford to Miss
The dual-eligible population is large, growing, and significantly underserved by current Medicare marketing and sales efforts. Most call centers treat D-SNP as an afterthought—a niche product mentioned only when a caller happens to volunteer their Medicaid status.
The agencies that win in D-SNP will be those that build dedicated capabilities: specialized agent training, D-SNP-specific routing, systematic screening in the call flow, and a consultative sales approach tuned to this population's unique needs and concerns.
The payoff is substantial—year-round enrollment eligibility, growing carrier investment in D-SNP products, a market expanding at 20%+ annually, and commissions that match or exceed standard MA. If you're not actively pursuing the D-SNP market, you're leaving significant revenue on the table and, more importantly, leaving vulnerable beneficiaries without the coordinated care they deserve.
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AgentTech Dialer's insurance-aware routing matches D-SNP callers to agents with the right state licensure, carrier appointments, and D-SNP training—with built-in compliance monitoring for every call.
Try AgentTech Dialer NowReferences & Authoritative Sources
The information on this page is supported by the following official and authoritative sources.
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Medicare.gov Medicare.gov
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