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Unique government health plans try to find an audience

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Medicare and Medicaid are key sources of health coverage for many Americans and some people qualify for assistance under both programs. With lagging enrollment for the unique plans, outreach efforts are underway.

According to KFF Health News, only about three in 10 people who qualify for Dual-Eligible Special Needs Plans were enrolled in 2021. Experts said the option is designed for people who need additional help because of disabilities, certain health conditions or their age.

Dr. Gina Williams, associate medical director for UnitedHealthcare, said the plans try to take a dynamic approach to serving those eligible.

"Everything from managing your wellness to managing your behavioral health needs and then everyday needs," Williams outlined. "It's kind of a more comprehensive package for people who need a little bit more support."

Everyday needs include meal benefits and bathroom safety devices. The National Council on Aging said D-SNPs aim to provide a more streamlined coordination of care because there is assistance in arranging the services. Wisconsin's enrollment numbers are similar to the national rate, at 28%.

Christine Huberty, lead benefit specialist and northern region supervising attorney for the Greater Wisconsin Agency on Aging Resources, said a tricky component of the plans is navigating provider network restrictions. A rural resident might have to travel farther to see a doctor covered under the plan and she cautioned it warrants careful research when enrolling.

"I would say first and foremost, look at the provider network restrictions," Huberty advised. "Look at what's available in your area."

Meanwhile, Williams noted the push to get more eligible people to sign up coincides with more awareness around preventive care in a post-pandemic world.

"Everybody's kind of going into a phase where they're not only thinking about acute illness, but they're thinking about overall care," Williams observed. "What was the impact of the pandemic from a psychological standpoint? Do you need more support and then you also need more coordination of benefits?"

Mike Moen is a radio news reporter with nearly two decades of experience in the field. He has covered much of the upper Midwest, including Minnesota, Illinois, Wisconsin and the Dakotas. Many of his stories have aired nationally, including several public radio programs.
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