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 is a reporter at AIS, specializing in public sector data research, trend analysis and infographics. She holds a Bachelor of Science in Journalism from Ohio University, joining AIS shortly after graduating in 2014.

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