Does "Full Dual Eligible" Always Mean A Client Has Full Medicaid?

RunnerDude

Super Genius
181
I have a client (68) with Medicare A&B and Humana Gold (HMO). "Medicare.gov" show that she is "Full Dual Eligible"- but does not have a Medicaid Card. I tried to contact SC Medicaid to check her eligibility - but could not get through. I was wondering- Does Full Dual Eligible (using Medicare.gov's definition) always mean that the individual has Medicaid- and is eligible for a Medicare Advantage Dual Plan?
 
I am thing "yes", I would make sure that her Doc accepts
the plan that she would possible want to apply for. I know
in the past I have contacted UHC producer help desk
and spoke with someone that could look up Medicaid status
and also they gave me the Medicaid # to list on the App.
Hope this helps.
 
I just always call freedom health. They pick up right away, tell me what their Medicaid status is and which plan they qualify for. Whether I use that company or not.
Medicaid will not answer your call
 
Usually this is the case, but sometimes Medicare.gov can be a bit delayed to get the updated information if there is a recent status change.

UHC's PHD can also verify Medicaid eligibility.
 
Hey Boss, this is what you need to do. Been working duals hard for about 6 1/2 years. On Humana generally, and they can tell you if you call Agent support for dual eligible check, they will either need qmb, qmb+, or slmb+, although all states don’t have slmb+. I’m betting this person you met with recently went on Medicare from Medicaid, , and the state did not automatically put them on qmb. They still have no out of pocket costs with that status, but probably won’t qualify for the desnp plan. Solution...fill out a new medicare savings application with your state and submit, within a matter of a few weeks they will get a qmb letter, then you can enroll. The new income requirement in most states for qmb is now $1,034...good luck, but that will solve it.
 
I am learning this market. So are you saying if someone gets under $1034 per month they are qmb and dont pay any premium or out of pocket for anything? I know med supps inside and out but this MA stiff is confusing as heck to me...
 
Yes, if income is under 1034 and single...Medicaid won’t count House or one vehicle regardless of value, as long as they don’t own other property, cds, investments etc. 1392 if they are married (combined income)
If you google qmb and balance billing, you will see it’s a federal law a qmb cannot be billed or asked for co pays by Medicare providers UNDER ANY CURCUMSTAMCES. It happens, but they have no legal obligation to pay
 
Are most of these people on medicaid already or do they just apply for the extra help and you enroll them in a ma plan?
 
Most of the ones I work with already have medicaid, but about once a week a find someone not enrolled, or qualified for slmb or extra help which I help with
 
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