Despite Phaseout, Look-Alike Plans Still Threaten Integrated Care for Duals

Payers’ increasing interest in offering integrated health plans for Medicare-Medicaid dual eligibles, namely Dual-Eligible Special Needs Plans (D-SNPs), also led to a proliferation in “look-alike” plans marketed to duals. The main difference — look-alike plans are not legally required to contract with state Medicaid programs on care coordination, a cause of concern for advocates and policymakers alike. As D-SNPs gained traction over the past decade, enrollment in look-alike plans also grew rapidly, according to a new study published in the July 2023 issue of Health Affairs. While CMS has already cracked down on look-alike plans — new regulations caused dozens of contract non-renewals for 2023 — the study authors suggest that look-alike plans still pose a potential threat to improving integrated care delivery for duals, who are often more medically and socially vulnerable than other Medicare beneficiaries.

© 2024 MMIT
Carina Belles

Carina Belles

Carina has been covering public-sector health care since 2018. As a data reporter for Radar on Medicare Advantage, she creates infographics and data stories on issues impacting Medicare, Medicaid and Part D. She also develops AIS Health Daily, a free daily newsletter that showcases AIS’s strong reporting across our four publications and parent company Norstella’s suite of market access and data solutions. Prior to joining the editorial team, she managed Medicare and Medicaid data for the Directory of Health Plans, AIS’s industry-standard health coverage database. She graduated from Ohio University with a B.S. in Journalism.

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