Context
A plan misalignment occurs when a plan sold is not a good fit for a member. A misaligned plan can occur with all types of plans, typically resulting in the beneficiary incurring higher out-of-pocket costs for co-pays and coinsurance than they anticipate.
Some examples of plan misalignments:
Devoted offers a C-SNP PLUS product for members for beneficiaries with chronic conditions and full Medicaid. While Medicaid is not required to be on this plan, it is needed to receive the cost-sharing aspects of the plan that are core to its offering.
A member enrolled in this plan who does not have full Medicaid is on a misaligned plan.
“Part B Giveback” plans are common across carriers and offer beneficiaries a “giveback” offer that pays a percentage of their Part B premium. This is often received as an addition to their social security check or as a reduction in their bill if not receiving Social Security.
While enrolling a member in a misaligned plan is not an immediate compliance allegation, members enrolled in misaligned plans are at risk of rapid disenrollment and CTMs due to the member not receiving the anticipated coverage and benefits.
Preventing plan misalignments is in the best interest of carriers, Spark, and its agency partners as it mitigates compliance risk and supports client retention.
Devoted CSNP+ Misfits
Devoted released a C-SNP PLUS product for CY2026, which is experiencing a high rate of misalignments due to members being enrolled who do not have full medicaid benefits.
Members without full Medicaid who are enrolled in this plan will not receive essential cost-sharing benefits and are not within the plan’s intended design. Partial duals (SLMB, QI, QDWI) are not the right fit for this plan.
Here are some useful resources covering the specific details of Devoted's CSNP offerings:
Preventing CSNP PLUS Misfits
If you are working with a CSNP-eligible client, confirm their medicaid status as a best practice before reviewing Devoted's CSNP+ as a potential offering. Sunfire and carrier portals have Medicaid Eligibility look-up features that can confirm the beneficiary's medicaid level.
Working with members enrolled in a misaligned CSNP PLUS plan
If you have a client who has been enrolled in a misaligned CSNP PLUS plan, a best practice is to reach out to the member and let them know about potential costs before the plan becomes active. Here are some suggested steps to take for outreach:
Please note - Devoted is doing intermittent outreach to members enrolled in CSNP PLUS plans without Medicaid. Devoted's team will connect with these clients and explain that their plan may have much higher costs than they expect. If Devoted's team enrolls one of your members in a new CSNP plan, the new plan will retain you as the Agent of Record (AOR).
Initial outreach explaining that their new plan may have unexpected costs.
"My team and I completed a secondary review of your upcoming coverage and identified that you may incur unexpected costs with certain aspects of your coverage."
Explain the current plans' association with Medicaid.
"Devoted's CSNP PLUS plan is designed for cost sharing with full Medicaid coverage run through your state. My team and I reviewed your information and confirmed that you do not currently have the Medicaid coverage to have your costs fully covered."
Request a secondary meeting to review potential plan options. A new SOA will be required.
"As a next step, I'd like to schedule a follow-up appointment with you to review the benefits you are eligible for on your existing plan and confirm that you are on the plan that is best aligned to fit your needs."
Complete an updated plan review with CSNP.
Giveback Plan Misfits
A Plan misfit occurs with a Part B giveback plan when the beneficiary does not pay their own Part B premium.
If a beneficiary receives assistance paying their Part B premium through Medicaid or other state/federal programs (QI, SLMB, QBMB, or full Medicaid), they will NOT receive the giveback.
The plan will not send the money elsewhere or reallocate the benefit - it simply will not be applied.
Preventing Part B Giveback Misfits
If you are working with a client who is interested in a Part B giveback Plan, confirm they fit into one of these categories below prior to enrollment:
Medicare enrollees not receiving premium assistance
Veterans using VA benefits (MA only plan)
Beneficiaries looking to offset Part D drug costs
Individuals who value premium savings over extra supplemental benefits
Working with members enrolled in a misaligned Part B giveback Plan
If you have a client who has been enrolled in a misaligned Part B giveback plan, a best practice is to reach out to the member and let them know about the Part B premium they will be responsible for paying before the plan becomes active. Here are some suggested steps to take for outreach:
Initial outreach explaining that they will be responsible for paying the full Part B premium.
"My team and I completed a secondary review of your upcoming coverage and identified that you will be responsible for paying the entire Part B premium amount."
Request a secondary meeting to review potential plan options. A new SOA will be required.
"As a next step, I'd like to schedule a follow-up appointment with you to review the benefits you are eligible for on your existing plan and confirm that you are on the plan that is best aligned to fit your needs."
Complete an updated plan review and potentially enroll in a different Plan.