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The problem that I see with the Dual & MA folks is that, the individual bears responsibility in making the plans work. They must be responsible to go to the right doctor (Dual Plans) some must switch doctors.
The most important thing they must "remember" is to show their new "Health Care" card. And quit frankly that seems to be way to much responsibility for most of these folks. In general these folks are so accustom to entitlement programs, and OK with everyone else taking care of them (i.e. goverment, social workers, or the manager at the housing facility they live at.) The "responsibility" train for these folks has left the depot years ago. That is if it ever was there. The same people who floated through school, and floated through adulthood seem to stay the same. They just get older.
Most of them don't pay any health care bill's anyway. And have all the benifits they can use anyway.
However, grandmothers will take out life policies on all their grandchildren and eat cat food before they will let the policies lapse. The only kicker is that the agent must go by each month and collect the premium. The few I have known who do that "carry" when they do.
Money is important, quality of life is more important.