How can community-based groups assist full benefit duals in selecting a better plan?
Community-based groups can assist in educating duals by providing information that will help the dual eligible choose a plan that best meets their needs. For example, community based groups can advise dual eligibles about the benefit of enrolling in the benchmark plans (no premiums). They can advise the enrollee about what plans cover the drugs currently used by the enrollee, the plan’s exception and appeal processes, utilization controls such as prior authorization, and what plans include the pharmacy that the enrollee wants to use. These groups, however, cannot direct the enrollee into a specific plan or enroll them in a plan.
