By Matt Berger
Jackson Advocate Guest Writer
The price of food has risen sharply over the past several years. High grocery bills – in addition to other daily costs pushed upward by inflation – have put a financial strain on many Americans, but particularly older adults living on a fixed income. At the same time, emergency food assistance that helped low-income individuals during the COVID-19 pandemic ended earlier this year, significantly reducing benefits that many older Americans relied on from the Supplemental Nutrition Assistance Program, also known as SNAP. These combined factors have forced tough financial decisions and increased food hardship for many.
More than one in five food-insecure households includes someone 65 or older – a population that is especially vulnerable to the health effects of food insecurity. Limited access to adequate, healthy food can cause or exacerbate chronic conditions such as diabetes, congestive heart failure, asthma and depression. It also restricts people from engaging in basic activities, with food-insecure older adults having daily living limitations comparable to those 14 years their senior.
Older adults who are eligible for both Medicare and Medicaid, known as dual-eligible beneficiaries, are at particularly high risk for food insecurity and its harmful effects, since they live with more chronic and complex conditions and have lower incomes than the general older population.
There are 12.5 million dual-eligible Americans; 60% of these beneficiaries are 65 years and older and almost 9 in 10 have an annual income of less than $20,000. About one in five dual eligibles have three or more chronic conditions. According to a study by Humana, 52% of dual-eligible beneficiaries experience food insecurity compared to 17% of non-dual eligibles.
Addressing Food Insecurity for Dual Eligibles
Research has shown that food assistance can make a substantial difference in the health of dual eligibles, reducing the likelihood of hospitalizations, emergency department visits and long-term care admissions.
What many dual eligibles may not know is that they can receive a food allowance benefit by enrolling in certain Dual Eligible Special Needs Plans (D-SNPs), which are special types of Medicare Advantage plans offered in many states through private insurers. D-SNPs are an alternative to having coverage through original Medicare and a state-run Medicaid program. In addition to covering Medicare Part A (hospitalization), Part B (outpatient medical services) and Part D (prescription drugs), and in some cases delivering certain covered Medicaid benefits, D-SNPs offer additional benefits that may include food allowances. For instance, all of Humana’s D-SNP members receive a Healthy Options Allowance, which provides between $35–$275 as a monthly allowance ($420–$3,300 annually), depending on the plan and location. This benefit can be used to purchase healthy foods and pay for other essentials that have an impact on health and well-being, such as rent and utility bills.
We have heard from our dual-eligible beneficiaries about how this allowance gives them some stability. One Humana Gold Plus SNP-DE H5619-123 plan member expressed what many others have told us about the positive impact the allowance has had on the budget: “The money I’m able to use from this benefit card is huge to me. I try to eat healthy, and I’m on a very, very tight budget.”
Filling Gaps in Care
Dual eligibles often have more complex and chronic health conditions than the general population. On top of that, they often struggle with basic living needs making it extremely challenging to properly manage the multiple treatments, regular monitoring and various physician visits that their health conditions may require.
D-SNPs, such as those offered by Humana, use a care team approach that helps patients better manage their health by providing additional patient support through a person-centered, comprehensive care approach. This includes assistance with coordinating the patient’s benefits and medical services, as well as connecting them to community resources, including transportation, food assistance and other social supports. These plans also fill other gaps in original Medicare coverage, such as routine dental, hearing and vision care that can have a significant impact on a person’s overall health and independence. What’s more, most beneficiaries pay minimal to no out-of-pocket costs for these plans, making them an accessible option for low-income adults. Most Medicare members must continue to pay the monthly Medicare Part B medical premium.
Enrolling in a D-SNP
Any person who qualifies for both Medicare and Medicaid is eligible to enroll in a D-SNP when available in their state. However, to be eligible for a D-SNP, individuals must first enroll in Original Medicare Part A and B and must have Medicaid coverage. Now that the COVID-19 public health emergency (PHE) has ended, it’s essential for people to make sure their state Medicaid program has their correct contact information and to check if they need to reapply to Medicaid to maintain coverage.
There are multiple times during the year when eligible individuals can enroll in a D-SNP:
• Initial Enrollment Period (IEP): A seven-month window, starting three months before the month the beneficiary turns 65 and ending three months after their birthday month.
• Annual Election Period (AEP): Runs from Oct. 15 to Dec. 7 each year. Individuals who are already enrolled in a D-SNP can change plans during this period. Coverage begins Jan. 1 of the following year.
• Special Enrollment Periods (SEP): These are times when eligible beneficiaries can enroll in a D-SNP based on a qualifying event, such as moving out of the current plan’s service area, becoming eligible for Medicaid, or when the current D-SNP is no longer available.
D-SNPs can provide vital resources and support for low-income adults that can improve their health outcomes and overall quality of life. To find out more, visit the Centers for Medicare and Medicaid Services website (https://www.cms.gov/medicare/enrollment-renewal/special-needs-plans/dual-eligible).
Matt Berger is Humana’s Gulf South Region Medicare President.