Do people on Medicaid have to take a D-SNP?

Apr 10, 2019

  1. J2727
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    J2727 Super Genius

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    For people who have Medicaid, do they have to take a dual SNP or can they also get a regular MAPD plan?

    I haven't seen anything about this.
     
    J2727, Apr 10, 2019
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  2. TwoCents
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    Well, considering D-SNPs aren't available in every county in every state, that's a no.
     
    TwoCents, Apr 10, 2019
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  3. Northeast Agent
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    Some D-SNP only accept full duals, although some do accept partials.

    Apparently, Humana (aka, "the Debil") offers plans designed to appeal to the Dual-Eligible beneficiary called "Value Plus Plans" (I'm reading the Humana DSNP Playbook). But unlike DSNPs, they maye be sold to applicants who are not Medicaid-eligible.

    There's not one in my market (there's a DSNP), but it says "some markets may offer both DSNP and Value Plus Plans."
     
  4. vic120
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    vic120 Guru

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    No, they do not, Some times they are auto-enrolled, However,

    I do have someone who refers to me, on occasion mostly people coming off MA to med supp

    But sometimes wants me to help a client on DSNP who wants to go back to OG medicare and PDP for reason of more freedom and because of preauth

    Also, You can even see on medicare.gov how much the PDP premium will be after Medicaid lowers cost
     
    vic120, Apr 10, 2019
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  5. grod
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    Not all MAPD plans coordinate with Medicaid, so the person may be liable for the copays.
     
    grod, Apr 10, 2019
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  6. vic120
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    Oh I missed that he wants to enroll into non Medicaid MA

    If that's the case if D-SNPs are available I wouldn't touch it except in the case of doing a favor putting someone on PDP but I would do reg MA unless no D-SNPs are available

    You could do it, But I find its better to walk away from those
     
    vic120, Apr 10, 2019
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  7. alphawave2k
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    Presumably the client who is a QMB would be better off with a DSNP plan built for them. I have found sometimes that even with a PPO, if their preferred Dr is not in network and they don't accept the plan, the enrollee would not benefit.
    I had a specific case where a lady insisted on keeping her specialist, whose office accepted her as a Medicaid recipient but was not in network. Before they accepted her new plan, they wanted to know what (UHC in this case), would comp them for office visits, etc. I could not get a straight answer from UHC on this. So it appears they would have received less with the plan than straight Medicare/Medicaid payout.
    After trying to deal with the Dr's office manager on several calls and emails, I decided it wasn't worth my time.
     
  8. bill3173
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    If they're a full dual eligible, a $0 Premium is the only one that you could consider writing them, and even then they would likely drop the plan, if it doesn't coordinate with Medicaid.
     
    bill3173, Apr 11, 2019
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  9. Chazm
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    I’ve only put one dual eligible client on a non d-snp. She had been with her Dr. for years and refused to leave him. He didn’t take any dsnp so I explained the difference and put her with uhc ppo. She was just happy to not have to pay the part b premium and MAPD
     
    Chazm, Apr 11, 2019
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  10. hockeyday
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    So how does that work with balance billing, ?
     
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