Evercare MAPD Plan for duel eligibles
- Thread starter jereri
- Start date
- 7,790
Hey, jereri, have you ever heard of the rules regarding capitalization? This not an instant messaging board. It is a professional forum.
- 15,319
The problem with the Duet Plan is that IT IS NOT A SNP. There is no advantage for the doctor to take this plan as he/she is still only getting paid 80% of Medicare - not the 100% WellCare told me they pay.
So now you have a low income person who may or may not be able to continue to see their doctor since the plan is really just a terrible PFFS (and I mean terrible because of their benefits). The doctor still has to bill Medicaid.
In some states the plan does add some dental and it given them a few bucks worth of OTC stuff, but the risk is that they lose their doctor and hospital.
As I said, I won't sell this because I don't want to restrict anyone's ability to see their physician. A true SNP is a managed care plan like an HMO. With this, both the client and the doctor should understand the restrictions which should not change during the year. With the PFFS, if the doctor decides not to see the patient, then the patient is out of luck.
Hope all this makes sense.
Rick
From what I know, the Evercare plan is a special needs plan but it is in that catagory because it is a SNP for low income or rather Dual eligibles.
Care Improvement Plus is as far as I am concerned a true SNP. You have to have Diabetes, COPD, CHF or ESRD(I don't think it is something I would sell to this group-no real benefit I can see). I am waiting to hear on the CIP plans for 08. I heard that they had a lot more people enrolled than they expected and that has I think almost overwelmed them. I have about 25 clients and they do like it, but they have been a little slow in paying claims the last month or so and I have gotten calls from clients wondering why they have gotten a bill. The bills have gotten paid.
Another thing on CIP is I have "heard" that the premiums may go up and the benefits may go down on the Gold Plan. Waiting to see it in writing first. I believe that the Platinum Plan premium may go up but benefits will stay the same. "This is what I heard"
My FMO said that Coventry may come out with a SNP, but they have not seen it.
Humana has one for osteoperosus, but what they said at a meeting didn't sound to impressive. Humana says 80% of seniors have this, so think it is a way to sell year round. I can't wait to be dissapointed with their SNP, and will be surprised if it is any good at all!
Hope this helps a little...
Scott
- 15,319
Actually, Evercare has plans for both dual eligible and chronic illness, the latter in selected areas for 2007.
I understand the chronic SNP will be expanded for 2008 and from what I can see, might be the plan to beat - especially if they brand it with AARP.
Their plan will include HBP as a qualifying "event". Like all chronic SNP plans, a beneficiary will have a one time, lifetime open enrollment in addition to the OEP effective Janaury 1.
Rick
OneMorePolicy
Expert
- 59
I'm reading some of the brochures about Evercare for medi-medi. Are the telemarketers\appointment-setting companies allowed to ask on the phone if the client has medicaid?
Last edited:
- 2,908
Yep. It looks like a good plan and yes diabetes and high blood pressure will make you eligible and apparently there is no acuity threshold or anything. If you are being treated for either of those then that is good enough. Its zero premium in my state. $1800 moop and coverage for all preferred generics through the donut hole. Plus it has goodies. Wellness products and vitamins and fluffy stuff like that that you can get each quarter for no additional charge so that people know that the plan still loves them. The other little thing that is strange but helpful is that if the spouse is medicare eligible but does not have any chronic illness then they qualify too.
I like the looks of those plans. The plus side is that they are year round. The downside is that even if they are ppo, your primary care physican must be in the network because the plan hinges on care coordination. You can still go outside with a higher copay for other docs who are not your primary. So your success depends on how strong your network is or how much heartburn is required to get the patients doc in- whether that is just a phone call from the company or a bigger and longer go around.
I think that it is an honorable product. If anyone is having luck with it and has a marketing strategy that is working- do tell. I doubt (but am not really knowledgeable here) that AARP will brand it because it is a little too specific for their one size fits all approach but dunno.
As an aside, if MA's survive which they will, I imagine at some point the chronic illness plans will really be more the model for the future because Congress will put more and more pressure on the MA's to demonstrate that they actually increase care coordination and achieve costsavings rather than the current unmeasured gravy train. My uninformed view anyway.
Winter
OneMorePolicy
Expert
- 59
Also wondering if an agent selling the plan to someone who has dementia (one of the 8 chronic illnesses) would automatically need to have the client's representative sign the enrollment form? Seems so since the client is medically considered not to have their full mental abilities?
If the enrollee has a power of att. then you should include them. You will be held accountable if you meet with a senior and they appear to not be together. Dementia comes in stages. Some people with a mild form of dementia are ok most of the time. An important question is to ask who helps them with their medicare decision. i have signed up several people on Evercare with Dementia but always had a family member involved.
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