Dual Eligible Clients- MN, MI, OH & WI

Feb 5, 2016

  1. lks288

    lks288 New Member

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    I am very new to the Medicare business (only been writing plans for about 2 months), and I've been having a very difficult time understanding exactly how the Medicare/Medicaid market works. I am only working with clients who are under age 65 and are eligible for Medicare because of SSDI benefits.

    The person in charge of my "training" has been giving me information that I seem to find untrue/incorrect so I am coming to the forum for some advice from more experienced agents. This forum has taught me more information about how to do this business than the YEAR of training I've done with my "upline"...

    Anyways- Here is my issue: I am working with clients in OH, MI & WI who are eligible for full medicaid benefits (FBDE). I understand that they are "auto-enrolled" in PDP's by the county, but have been advised by my upline that these plans are almost always "sub-par" to a MAPD plan. The issue is finding a MAPD plan that will include their doctors and Rx's. My upline says that regardless of the plan- Medicaid will cover any Rx's not on the formulary and will also cover any copays/coinsurance charges for doctors NOT in the network. I find this very hard to believe given the research I've done that basically states the complete OPPOSITE of that!

    Does anyone here have ANY information about this? I am concerned about enrolling these clients in plans that will not coordinate with Medicaid and put them at risk for cost-sharing. I have basically avoided enrolling ANY of them into plans, but according to my "upline", I am missing out on a lot of potential commissions for these people. At this point, I dont feel comfortable putting these people into plans that list doctors not in network and Rx's not on the formulary because they are people with a lot of health issues who cannot afford to go without Rx's or doctor visits.

    Thanks in advance to anyone with any helpful information..
    lks288, Feb 5, 2016
  2. Newby

    Newby Guru

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    My advice is to join Greensky's (Rick's) Medicare101 Group and start reading. Search for posts by Greensky and click on his links.
    Newby, Feb 6, 2016