Advantra RX LIS/Medicaid Billing Problem?

Jan 12, 2009

  1. jdeasy
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    I've had several LIS/Medicaid folks call me today because they are getting a coupon book for $8.50/mo in premium. The threshold in Ky and In is $34/mo. The Advantra RX Value plan is $24.40/mo.

    Advanta won't answer the phone. You get a prompt saying that they are busy, call back later and they hang up.

    Anyone else having this problem about the premium?
     
    jdeasy, Jan 12, 2009
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  2. jdeasy
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    Yeah, I know. It's not funny to the enrollees though. I don't repesetn Advantra anymore because of Parker and Asses. I helped a few people change to the Advantra RX Value because they were gettin $8/mo premium coupons from Humana because Humana raised their premium to $42/mo. Medicare advised some of them to go with Advanta RX and some were advised by their pharmacists.

    I can change them to a plan that will be under the threshold. I just shouldn't have to.
     
    jdeasy, Jan 12, 2009
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  3. policy doctor
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    JD...what is this threshold in KY that you referenced? Are you saying it's diff am'ts per state? If so, where do you get this info from? Nothing ever mentioned to me.

    Seems like all carriers are using voice menu..for agents/broker lines are not being answered. Must be a mad house.
     
  4. Russ
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    Scroll down to bottom of page on link and it lists each state.....

    Medicare Part D AARP MedicareRx Plans - Low-income Subsidy
     
    Russ, Jan 13, 2009
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  5. policy doctor
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    I apreciate that Russ. I think I had one dual in AEP and wrote up Evercare for him. Hoping that will be problem free since low income usually isn't...acc to some agents here.
     
  6. jdeasy
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    What I learned is that the the threshold amount is the maximum. Plans can submit to CMS what they will accept as payment for their plans up to the maximu, In the case of Advantra, they accept $15.90 towards the $24.40/mo premium for the Value plan. That leaves the LIS/Medicaid person with $8.50/mo. Not being able to get information from the company because of Parker and Asses, I had to go on information from Medicare and was given wrong information.

    Last night, Medicare gave me a list of plans that were $0 premium for LIS, they included Community CCRX, SilverScripts, etc. Wellcare's Classic has a $.90/mo premium.

    Then you have formulary problems. Such as with Wellcare, the premium is $.90/mo, but generics are $0 co-pay. Sounds like a good deal? Unless the person is taking Lipitor which is not on the formulary, so, they would have to pay $82 for a one month supply. The CCRX plan covers lipitor, but, other common meds are not in their formulary.

    All this for $25. What a deal.
     
    jdeasy, Jan 13, 2009
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  7. policy doctor
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    Thanks for that info, JD. Sounds like too much work for too little pay. I ain't spading that garden!
     
  8. retread
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    Russ's link to AARP's info is good, but here's a quick way to tell without having to do the math:

    Go to the back of the Medicare & You Book to the PDP plans. Read the note at the bottom of each page... you will note that for every plan premium printed in BLUE, the LIS subsidy results in a cost of $0 for that beneficiary. Those BLUE premiums are below the state subsidy limit.
     
    retread, Jan 13, 2009
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  9. jdeasy
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    That is very good information. I had never noticed that before. Thank You!
     
    jdeasy, Jan 13, 2009
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