Dual Eligibles (Medicare & Medicaid)

Melo5457

Expert
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If a Beneficiary is receiving Full Medicaid and has Medicare, and they elect NOT to enroll in a Medicare Advantage Special Needs Plans for Dual Eligibles, but decide to enroll in just a regular Medicare Advantage HMO Plan for whatever reason, I need to know what damages will this do to them in the area of out of pocket expenses.
.
Now as you know full medicaid beneficiaries will pay $0.00 on these dual plans, and have a lot more benefits like transportation, dental vision...Question is-- will this person out of pocket expenses be the same on the regular HMO plan, (because the do have Full Medicaid), or will they actually incur some charges?
I was told once that they do not have to enroll in the Dual Plans and I understand that, but I am concerned about the costs they may be responsible for if they elect another type of Plan?

Thanks
Melo (Melo always)
 
If a dual enrolls in just MAPD, not a DE-SNP. They could have out of pocket expenses. It really depends if they are using providers that accept Medicaid & the plan. They need to determine if the providers they are going to accept Medicaid & the plan, if they don't they will be responsible for the cost sharing of the plan. They also have to get care in the state they get Medicaid benefits for Medicaid to coordinate benefits. If a resident of FL goes to GA or AL, FL Medicaid not going to pay doctors in other states, just the plan
 
If they enroll in a MAPD they are responsible for Part B premiums. If enroll in a MAPD for dual eligibles, the Part B premium is paid by the state.
 
Yes if they qualify for a Medicare Savings Program, that is when their Part B premium is taking care of by Medicaid.
 
QMB/QMB+ =
If a Beneficiary is receiving Full Medicaid and has Medicare, and they elect NOT to enroll in a Medicare Advantage Special Needs Plans for Dual Eligibles, but decide to enroll in just a regular Medicare Advantage HMO Plan for whatever reason, I need to know what damages will this do to them in the area of out of pocket expenses.
.
Now as you know full medicaid beneficiaries will pay $0.00 on these dual plans, and have a lot more benefits like transportation, dental vision...Question is-- will this person out of pocket expenses be the same on the regular HMO plan, (because the do have Full Medicaid), or will they actually incur some charges?
I was told once that they do not have to enroll in the Dual Plans and I understand that, but I am concerned about the costs they may be responsible for if they elect another type of Plan?

Thanks
Melo (Melo always)

There is a difference.

QMB/QMB+ is supposed to be cost-share protected, doesn't matter if it's Original Medicare or Managed Care, or if they accept Medicaid at all.

FBDE/SLMB+ requires that they use a Medicaid provider.

Unfortunately the documentation isn't great.
 
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