DSNP and Deeming Period Question

[Limozine]

I have a client who whose Medicaid level was downgraded in December. He's been on a Humana plan for full duals, and they've sent him a letter stating that his coverage will end on June 1st. He has some expensive procedures several times a month and is just barely over the income threshold. Will Humana continue to pay his claims in full as if he was fully dual until June 1st? And will he have a SEP to enroll in a new plan in May (since he'll be several months past the date he actually lost full status)? I hate to move him to a plan that won't cover everything 100% if he can continue to get full coverage through May.

 

[straightnochaser]

I have a client who whose Medicaid level was downgraded in December. He's been on a Humana plan for full duals, and they've sent him a letter stating that his coverage will end on June 1st. He has some expensive procedures several times a month and is just barely over the income threshold. Will Humana continue to pay his claims in full as if he was fully dual until June 1st? And will he have a SEP to enroll in a new plan in May (since he'll be several months past the date he actually lost full status)? I hate to move him to a plan that won't cover everything 100% if he can continue to get full coverage through May.

No they will not, you wanna get him off that plan.

 

[hockeyday]

I have a client who whose Medicaid level was downgraded in December. He's been on a Humana plan for full duals, and they've sent him a letter stating that his coverage will end on June 1st. He has some expensive procedures several times a month and is just barely over the income threshold. Will Humana continue to pay his claims in full as if he was fully dual until June 1st? And will he have a SEP to enroll in a new plan in May (since he'll be several months past the date he actually lost full status)? I hate to move him to a plan that won't cover everything 100% if he can continue to get full coverage through May.

They will not, find out if the place he is going to has a patient assistance program that will pay the co-pays

 

[DonP]

He's going to have 20% copays depending on the plan . I'd say if he was going in the hospital few to no low income people pay there daily hospital bills as that's written off . But if he's getting several procedures a month they probably won't let that slide . As Hockey said try to get him in a patient assistance program

 

[annon123]

Also find out if the hospital (or doctor's office) will cut off care if he falls too far behind in his payments and/or will sue him. If they do neither then you have a cushion to sort this out. If they will cut off care (or sue) that usually happens when they get sent to collection. As a result it would be worth finding out how long it takes to be sent to collection and how small a payment will keep him out.

 

[wehotex]

I have a client who whose Medicaid level was downgraded in December. He's been on a Humana plan for full duals, and they've sent him a letter stating that his coverage will end on June 1st. He has some expensive procedures several times a month and is just barely over the income threshold. Will Humana continue to pay his claims in full as if he was fully dual until June 1st? And will he have a SEP to enroll in a new plan in May (since he'll be several months past the date he actually lost full status)? I hate to move him to a plan that won't cover everything 100% if he can continue to get full coverage through May.

Humana will not treat him like a Dual if he doesn't have it any more. A tricky agent once managed to "sneak" my SMLB customer to a Humana DSNP. Somehow, Humana approved it even though it is really for QMBs. Once he started using it, he was being charged 20% at every turn including a costly hospital stay. After that experience, I quickly switched him back to Humana CSNP.

 

[DonP]

Humana will not treat him like a Dual if he doesn't have it any more. A tricky agent once managed to "sneak" my SMLB customer to a Humana DSNP. Somehow, Humana approved it even though it is really for QMBs. Once he started using it, he was being charged 20% at every turn including a costly hospital stay. After that experience, I quickly switched him back to Humana CSNP.

That was when the the checking of Medicaid was down from feb- sept. Heck i was curious the other day and ran a Medicaid check on humana and it was still spinning . Months ago everyone said it was up. I like running the Medicaid check on Jarvis or Aetna as they show partial or full duals Medicaid #'s . I've yet to see a partial dual pay 1 cent of a hospital stay whether its was copays of $350 a day or 20% . I run into to tons of partial duals with the 20% and high food cards and they are all happy and won't switch