Dual eligible individuals exclusively aligned in FIDE SNPs can expect more seamless experiences across Medicare and Medicaid, compared to even those dual eligible individuals whose enrollment is aligned in HIDE SNPs. This is because a FIDE SNP’s entire membership is receiving Medicare and Medicaid benefits from the same organization, which allows them to provide members a single ID card for both Medicare and Medicaid benefits, an integrated provider and pharmacy directory, an integrated formulary, one health plan customer service number, a single care manager who can manage across all services, one process for appeals and grievances, and more seamless care coordination with most all benefits covered under the same organization.
However, timing will be important for dual eligible individuals wishing to enroll in a FIDE SNP, as exclusively aligned enrollment in Hawaii requires that a dual eligible individual must first be enrolled in a QI MCO in order to enroll in the same organization’s FIDE SNP.
For example, a dual eligible individual wishing to enroll in a FIDE SNP, but whose QI and Medicare benefits are provided by different organizations, would first need to request to enroll in the QI MCO offered by the same organization that offers their desired FIDE SNP enrollment choice. In most cases, MQD limits QI MCO changes to the Annual Plan Change Period in October of each year. This means that most new enrollments into FIDE SNPs will be limited to the QI Annual Plan Change Period, which is typically October 1 – October 31 annually. (See Question 14 for how Hawaii’s modified Annual Plan Change Period, effective through July 31, 2024, impacts enrollment into FIDE SNPs).
There are some circumstances where dual eligible individuals may enroll in a FIDE SNP outside of the QI Annual Plan Change Period. For example, a dual eligible individual whose Medicare and Medicaid enrollment is aligned under their current HIDE SNP would be able to enroll into that organization’s FIDE SNP throughout the year as long as they have an available Medicare Special Election Period (SEP).