Dual Eligible Experts

[Dowejonez]

I took a dual off a supplement two years ago and put her on Wellcare, which is and was the only SNP in that county. Now that Wellcare has pulled out for 2010 should I do anything with her?

I never thought her med sup did anything for her and I thought her Wellcare gave her a few little extras per month, but should I just do nothing now? Of course she has her stand alone PDP.

 

[Yoda]

You should of left her on the med supp in the first place so she wouldnt have had to keep messing with it! Im not exactly following you here but yea you owe it to her to do something being you are the one that got her into this mess.

 

[stormtracker]

I thought that Wellcare was an MAPD-- but you say she has stand alone part D? What supplement could she have had since she was a dual?

 

[HealthResourceAdvisor]

How does a dual afford a supplement and why would they waste the money if they could? The state medicaid is covering the 20% medicare doesnt whether they have a supplement or not. If there are no other dual MA plans that give them a couple add-on benefits then i would just leave them alone with their medicare/medicaid/pdp.

 

[stormtracker]

Dow, I'm thinking that you might be confusing some terminology. Not being critical, but the scenario you presented in this thread is hard to fathom. I can't think of an instance in which a dual should be on ANY supplement-- much the less, part D. Further, I'd be concerned that such a situation might jeopardize the dual's continued eligibility for Medicaid. On the other hand, a person that qualifies for a SNP simply by virtue of medical condition would certainly be a good candidate for a supplement-- provided they can get underwritten...

 

[jdeasy]

I took a dual off a supplement two years ago and put her on Wellcare, which is and was the only SNP in that county. Now that Wellcare has pulled out for 2010 should I do anything with her?

I never thought her med sup did anything for her and I thought her Wellcare gave her a few little extras per month, but should I just do nothing now? Of course she has her stand alone PDP.

If the person is a QMB plus, {full medicaid}, they should have not been on a med sup sup to start with. Wellcare is not an SNP. {Well, maybe it is where you are?}

If the person is a QMB/LIS/QU1 dual, an MA/MAPD plan may be of benefit.

With Wellcare ending, you can move her to a med sup on a GI basis. I just did one today for an LIS dual. She was on Wellcare's Sonata PFFS. She gets her part B premium paid and her part D. She is not a QMB Plus and needs something to pay the Medicare deductables and co-insurance. I really don't think that she can afford the med sup, but, she insists that she is done with MA plans and wants a med sup. If I didn't sell her one, she was going to somebody that would.

You need to find out what level of dual this person has. If she is truly a medicaid enrollee, there is nothing for her that she needs. If there is a true SNP available, that might be of benefit to her.

 

[G.Gordon]

I've ran into some duals that have a spend down of $300-400/mo so they carry a supplement to protect that spend down dollar. It covers first dollar expenses. I may be wrong in understanding their situation and have asked them if they asked their case worker at medicaid and they said that they were told they could/should keep it.

It didn't make sense to me so I kept my distance. Why spend $110-140/mo 100% of the time to protect $300-400/mo on the occasions your medical bills reach that level.

 

[jdeasy]

I've ran into some duals that have a spend down of $300-400/mo so they carry a supplement to protect that spend down dollar. It covers first dollar expenses. I may be wrong in understanding their situation and have asked them if they asked their case worker at medicaid and they said that they were told they could/should keep it.

It didn't make sense to me so I kept my distance. Why spend $110-140/mo 100% of the time to protect $300-400/mo on the occasions your medical bills reach that level.

I've run into those as well. They can legally keep a med sup for those spend down dollars. An MA makes much more sense for those folks, but, to each his own.

 

[Dowejonez]

I thought that Wellcare was an MAPD-- but you say she has stand alone part D? What supplement could she have had since she was a dual?

I believe as late as 2008 Wellcare sold a plan just for duals called the Duet. It was an MA. She had an assigned PDP, from CCRx. I did not rewrite that.

I was pretty PO'd that there was no gatekeeper in place to keep her from throwing away money on a sup.
- - - - - - - - - - - - - - - - - -

How does a dual afford a supplement and why would they waste the money if they could? The state medicaid is covering the 20% medicare doesnt whether they have a supplement or not. If there are no other dual MA plans that give them a couple add-on benefits then i would just leave them alone with their medicare/medicaid/pdp.

This is exactly what I thought. She didn't have much money left over at the end of the month after she paid for the sup. I didn't think she really even needed the MA except for a few extra benefits she wouldn't get through Medicaid.

The way I met her is at 85, she became the live in girlfriend of a 79 year old client of mine. Otherwise I probably would not have given her the MA.

I'm thinking just leave it alone, but i'm going to talk to her case worker first. I don't know about other states, but here in Iowa it's hard as hell to reach anyone with the state to talk to. When you do they cannot answer the question.

 

[kennethbroyles]

In most states, I know TN and GA....... never put a dual on MedSup!

as was said before, state pays all co-pays and/or deductable. All the apps I write ask if they have medicaid. i didnt think they would even issue. I know even old indemnity products Cancer ect. will return permiums for all the past premiums because they could not produce a statement .
​