Disabled Prospect Wants MAPD

[eagles12]

I was contacted through referral by an individual who told me he is on full disability from the state. He turns 65 in three months. When I met with him , he told me he paid nothing for Dr Visits or prescriptions. He has an MA for PDP.

He would be out-of-network for his PCP with the plan(a PPO) I recommended. He primarily wants the plan for it's "0" cost health club membership .
He is not a dual eligible person either.
What would you do? Thanks.

 

[Fisher]

Well to start with I wouldn't recommend a plan that doesn't have his doctor in-network. What health (not PDP) coverage is he on right now?

 

[somarco]

Are you trying to write the plan now or for 3 mo out when he T65?

 

[yogooglethis]

I was contacted through referral by an individual who told me he is on full disability from the state. He turns 65 in three months. When I met with him , he told me he paid nothing for Dr Visits or prescriptions. He has an MA for PDP.

He would be out-of-network for his PCP with the plan(a PPO) I recommended. He primarily wants the plan for it's "0" cost health club membership .
He is not a dual eligible person either.
What would you do? Thanks.

just because he is T65 doesn't mean he needs to change his MAPD plan- especially if his doctors accept his current plan.If he still wants to change just for the free gym membership than I would call the doctors office and make sure they are willing to accept the plan OON and fully explain that he may have to pay 30-50% for some additional services received at OON PCP

 

[eagles12]

he's on state assistance. His PDP is with Humana. according to him he's not on an MA plan. Also, this is being written by as a T65 three months out.

 

[Todd King]

he's on state assistance. His PDP is with Humana. according to him he's not on an MA plan. Also, this is being written by as a T65 three months out.

You did state originally that he was on an MA plan for PDP. I would bet he is on Medicare and Medicaid, which pretty much takes care of everything except very small copays for his meds.

 

[yogooglethis]

he's on state assistance. His PDP is with Humana. according to him he's not on an MA plan. Also, this is being written by as a T65 three months out.

He is on medicare and pays no copays for pcp? so if he is on just a pdp then he must have medicaid or if he doesn't have medicaid he has a humana mapd that covers his pcp for o copay. Not sure i would advise to switch for a free gym membership if he has to see his pcp oon.

 

[hlb96]

He could be dual eligible and on a Humana SNP MAPD. Ask to see their card or have them read the info off their card to you ( at least the bottom right that starts with CMS)