Drug costs for client with partial Medicaid

[Limozine]

Situation: client has partial Medicaid and LIS. In SC there is only one plan designed for partial duals (it's with UHC), and they require a verification letter. We call Medicaid and asked for the letter. Client says he never received it. I've urged him to visit the local Medicaid office and get it so that he can get on this plan but he is dragging his feet. My question: if I put him on a non-dual plan during AEP, can I assume that he will pay the $4.90 or so for generics that the plan SOB lays out? Or will his dual status (even though partial) mean he'll pay less?

 

[Special Agent]

Situation: client has partial Medicaid and LIS. In SC there is only one plan designed for partial duals (it's with UHC), and they require a verification letter. We call Medicaid and asked for the letter. Client says he never received it. I've urged him to visit the local Medicaid office and get it so that he can get on this plan but he is dragging his feet. My question: if I put him on a non-dual plan during AEP, can I assume that he will pay the $4.90 or so for generics that the plan SOB lays out? Or will his dual status (even though partial) mean he'll pay less?

medicaid status does not effect the LIS level.uhc jarvis medicare eligibility will show you level of lis and that is what he will pay.For the medicaid create an online account for them and print out benefit letter.once you do this for them they will be your client for life- or at least until another agent calls them and offers a higher food benefit .lol

 

[BibH]

That plans pain in ass with uhc in sc . I’ve sold a few but I’ve had 1 disenrolled . I’d recommend selling the new csnp with $141 food card and $3 k dental with United if they have lis, partial Medicaid and heart or diabetes issues . Your correct in all plans but the partial dual they will have small copays even with lis . The award letter in sc with healthy connections is tricky . Sometimes it lists little and United won’t accept . Because sc Medicaid doesn’t list partial Medicaid levels it’s why only United has partial dual .I used to write the $50 food card Humana 280 for partials but that’s down to $25 now and crap .

 

[BibH]

medicaid status does not effect the LIS level.uhc jarvis medicare eligibility will show you level of lis and that is what he will pay.For the medicaid create an online account for them and print out benefit letter.once you do this for them they will be your client for life- or at least until another agent calls them and offers a higher food benefit .lol

That won’t work in sc . It has to come from Healthy connections directly . Sc does not show any levels of Medicaid on partial duals on eligibility platforms .

 

[Special Agent]

That plans pain in ass with uhc in sc . I’ve sold a few but I’ve had 1 disenrolled . I’d recommend selling the new csnp with $141 food card and $3 k dental with United if they have lis, partial Medicaid and heart or diabetes issues . Your correct in all plans but the partial dual they will have small copays even with lis . The award letter in sc with healthy connections is tricky . Sometimes it lists little and United won’t accept . Because sc Medicaid doesn’t list partial Medicaid levels it’s why only United has partial dual .I used to write the $50 food card Humana 280 for partials but that’s down to $25 now and crap .

So if you log in to healthy connections you can't archive the letters that were sent out?Ok good to know i have never written a dual in SC so i have never had to create an online account .i did recently write that UHC Chronic plan for someone with level 1 LIS in SC and it is a pretty awesome plan.For someone who has the 15% LIS level it may not be so awesome if they are taking brand name drugs though

 

[BibH]

So if you log in to healthy connections you can't archive the letters that were sent out?Ok good to know i have never written a dual in SC so i have never had to create an online account .i did recently write that UHC Chronic plan for someone with level 1 LIS in SC and it is a pretty awesome plan.For someone who has the 15% LIS level it may not be so awesome if they are taking brand name drugs though

What’s 15% lis level? Starting in 2024 it’s 100% level or nothing

 

[Special Agent]

What’s 15% lis level? Starting in 2024 it’s 100% level or nothing

holy crap you are right i didn't get that memo and i sure as hell don't read the ahip slides

I know some Eliquis using level 1 lis clients that are going to be happy about this.

Out-of-pocket drug costs​

Subsidy Levels	Deductible	Copayment*
Level 1	$0	$4.90/$12.15
Level 2	$0	$1.60/$4.80
Level 3	$0	$0/$0