Many states are focused on improving care delivery for the over 12 million people in the U.S. who are dually eligible for Medicare and Medicaid. State Medicaid agencies are increasingly contracting with Dual Eligible Special Needs Plans (D-SNPs) to advance integrated care goals. For state officials actively working with Dual Eligible Special Needs Plans (D-SNPs) to advance integration, or those newly examining ways to enhance D-SNP contracts, it is essential to understand how the federal Medicare Advantage program works.

This Medicare Advantage Policy Basics online training series is designed to support Medicaid and partner agency staff as they build needed Medicare capacity. Training modules include:

  • Contracting and Bid Development – Explores the Medicare Advantage contracting process, including the components of the Medicare Advantage application and the annual contracting timeline. Also describes the different elements that make up a Medicare Advantage bid and how bids are used to determine plan payment.
  • Payment Policy and Rate Setting – Looks at how Medicare Advantage plans are paid, including some of the unique aspects of Medicare Advantage payment policy applicable to D-SNPs. Also highlights key drivers of Medicare Advantage payment rates and considerations that may impact plan revenue and benefit design.
  • Supplemental Benefits – Highlights the different types of Medicare Advantage supplemental benefits and their relevance to Medicare Advantage enrollees, health plans, and state officials. Also highlights factors affecting Medicare Advantage plan benefit design, as well as policy and program design opportunities available to states.
  • The Star Rating System – Delves into the purpose and key features of the Medicare Advantage Star Rating system, as well as its importance to consumers, health plans, and the Centers for Medicare & Medicaid Services. Also describes the relevance of the rating system to Medicaid agencies partnering with D-SNPs.

Each video module explores foundational Medicare knowledge, select policy and program design opportunities, why features of the Medicare Advantage program matter for Medicaid agencies, and resources available for states. While geared toward a state audience, other Medicaid program partners including advocates, health plans, and providers may find these trainings helpful.

The video training series is a product of the Center for Health Care Strategies’ Medicare Academy: Capacity-Building for States Advancing Medicare-Medicaid Integration. Made possible through support from Arnold Ventures, The Commonwealth Fund, and The SCAN Foundation, the Medicare Academy supports Medicaid agencies focused on building the Medicare capacity needed to advance integrated care.