Does "Full Dual Eligible" Always Mean A Client Has Full Medicaid?
- Thread starter RunnerDude
- Start date
wallstwizard
New Member
- 19
There would be no reason for a qmb to sign up for a regular ma plan...that should only been done for medicare only folks...otherwise they will have co-pays associated with those plans, and the state medicaid office will not coordinate benefits and pay those amounts, so you would be putting the beneficiary in a terrible position....the ONLY reason for a qmb to sign up for a snp is to get the free stuff (dental, glasses, transportation, or whatever the carrier offers
- 2,115
Besides the "free"stuff, they are getting access to more doctors as well. A lot don't accept just Medicaid.
DGoldberg
New Member
- 11
^^^ This
Also make sure to check networks, etc as in some cases the provider may take the state medicaid but not the carrier plan for certain reasons.
XpressInsurance
Super Genius
- 244
The Dual SNP plans are great for the "free stuff". UHC & Humana offer dental usually anywhere from $1000-2500 in free dental, plus vision contacts or glasses. In addition these plans usually offer a good over the counter benefit. In some markets in $250 per quarter for things they would buy at drug store. I can tell you that customers love that, they have more money to spend on grandkids, groceries or whatever.
It has been my experience the Dual SNP customer base is very loyal & they will tell all their friends, just beware not all the friends are eligible.
You can call UHC Producer Help desk or Humana's Producer Help number to verify eligibility.
Last edited:
wallstwizard
New Member
- 19
There are only a few reasons they will not sign up, or shouldn’t be signed up:
1. Doctors not in network
2. Prescriptions not on formulary
3. Home health or durable medical equipment provider not in network
4. Fear something will change for them.
Doctors not in network can be overcome depending on situation. If they are going to see pc and state run facility and didnt realize they can see private doctors, it can be smooth transition.
Formulary problem, I avoid this situation unless there is a clear comperable substitution, but proceed with extreme due diligence.
Home health and durable medical equipment can be done, but you better set that up with primary care doctor and other provider before you leave the home. Even when you get another home health provider set up, home health nurse may come in and say well you can’t get home health anymore because you dropped Medicare, or something crazy like that, so you have to explain they are still on Medicare, but that the plan will administer the Medicare benefits and be billed instead of Medicare, as Medicare is paying the plan each month they are on plan. I also explain they are able to leave that plan at any time during the year.
But if those things are not an issue, and I address this at the beginning of the appointment, you need to repeat multiple times this plan does not cost you anything. Because when they hear about all the benefits it will sound too good to be true.
You want to give them a copy of the prohibition on balance billing from the centers of Medicare and Medicaid, and explain it’s a federal law they cannot be billed under any circumstances. And trust me, certain people will get bills. They need to be clear on what cards to show to whom, but they will sometimes forget to show medicaid which will result in a bill. Other times medicaid may not pay their entire 20% resulting in a bill. But the law states that the Medicare payment, and Medicaid payment, (IF ANY) IS CONSIDERED PAYMENT IN FULL to the provider. I tell them to call me if they hAve an issue, and I take care of it personally, first by being nice, but if that doesn’t work I send a nasty letter to the doctor and to billing department citing the law about the potential for the provider to be sanctioned.
1. Doctors not in network
2. Prescriptions not on formulary
3. Home health or durable medical equipment provider not in network
4. Fear something will change for them.
Doctors not in network can be overcome depending on situation. If they are going to see pc and state run facility and didnt realize they can see private doctors, it can be smooth transition.
Formulary problem, I avoid this situation unless there is a clear comperable substitution, but proceed with extreme due diligence.
Home health and durable medical equipment can be done, but you better set that up with primary care doctor and other provider before you leave the home. Even when you get another home health provider set up, home health nurse may come in and say well you can’t get home health anymore because you dropped Medicare, or something crazy like that, so you have to explain they are still on Medicare, but that the plan will administer the Medicare benefits and be billed instead of Medicare, as Medicare is paying the plan each month they are on plan. I also explain they are able to leave that plan at any time during the year.
But if those things are not an issue, and I address this at the beginning of the appointment, you need to repeat multiple times this plan does not cost you anything. Because when they hear about all the benefits it will sound too good to be true.
You want to give them a copy of the prohibition on balance billing from the centers of Medicare and Medicaid, and explain it’s a federal law they cannot be billed under any circumstances. And trust me, certain people will get bills. They need to be clear on what cards to show to whom, but they will sometimes forget to show medicaid which will result in a bill. Other times medicaid may not pay their entire 20% resulting in a bill. But the law states that the Medicare payment, and Medicaid payment, (IF ANY) IS CONSIDERED PAYMENT IN FULL to the provider. I tell them to call me if they hAve an issue, and I take care of it personally, first by being nice, but if that doesn’t work I send a nasty letter to the doctor and to billing department citing the law about the potential for the provider to be sanctioned.
wallstwizard
New Member
- 19
I would say anyone that has both Medicare and Medicaid, or someone with Medicare that is eligible for Medicaid. If you have more than one special needs plan in the area, they may not be on the one that best suits their needs in terms of extra benefits. But even if they are, but don’t have an agent, or a crappy agent that never explained their extra benefits, you can still do agent of record change and capture renewals
wallstwizard
New Member
- 19
humana for sure, probably uhc. Just want to have the client write in their OWN HANDWRITING:
date:
"Please have john doe be my agent of record effective immediately." print name
sign name
then you write out:
Humana ID #
DOB
Zip code
Agent name
SAN#
date:
"Please have john doe be my agent of record effective immediately." print name
sign name
then you write out:
Humana ID #
DOB
Zip code
Agent name
SAN#
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