This has always been a gray area for me. It seems that the insurance companies and Medicaid pass the buck on the answer. When is someone responsible to pay for the d-snp premium on plans? I realize that full dual means they pay nothing. But at what level do they have to pay the premium? SLMB? Qi? etc. And does LIS level have anything to do with it? I have a customer who is slmb and Partial dual eligible, LIS level 1 in Florida. Any help would be appreciated. Thanks!
full vs partial d-snp premiums
- Thread starter keith365
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In my experiences, it’s the LIS that pays the nominal premium, not the Medicaid. Since all of the Medicaid levels have LOWER income limits than LIS, the LIS is always Level 1-100%.
When I was in California, there was a “share of cost” Medicaid where those with HIGHER incomes than LIS would qualify for Medi-Cal share of cost and qualify for a Partial plan that was offered WITHOUT LIS. I’m sure that the rules vary by state.
One of the plans (Devoted) allows a person without LIS to “buy up” to a higher option plan for about $20 or so, but it’s not a Dual plan.
From my understanding the only way a dual or partial dual will ever have a premium is if they lose Medicaid AND lis at same time . Ive never seen that happen . So if a dual or partial dual loses Medicaid they get to stay on the plan for 6 months with full cost sharing but no premium . That 6 months gives them time to reapply for Medicaid . As Webotex said lis is paying the premium on the plans . I sell the tar out of a lis plan that’s around $35 a month . A non lis can buy for $35 a month but it has a $505 deductible. I sell 99% to lis only as the drug deductibles waved and no $35 a month .
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Qi1 is the lowest level of Medicaid . They will only qualify for a partial dsnp and will be subject to full cost sharing on all copays and coinsurance just like a regular mapd . The plan won’t have a premium as their lis status pays it.The only 2 benefits are possible $0 copays for all drugs and they don’t pay the $164.90 part B premium and of course rich benefits on a partial dsnp .
Though typical, not always true. We have Qi partial Medicaid plans that have all $0 copays. You don’t want to put a partial with UHC but several other companies have partial plans with $0 copays.
Your saying QI1 partial Medicaid has $0 yearly moop ? But them again Fla has $900 moops on regular plans so $0 on partial Medicaid wouldn’t be a big deal . I assure 98% of states don’t have that because most min moops are $3k and avg moops over $7k
yes, two that quickly come to mind are Simply and Freedom. Zero down the board and you qualify with Qi
We don’t have a $900 MOOP on a regular plan in central Fl. Maybe Miami.
I just looked . In Tampa I counted about 7 plans with under $1900 moops and 1 with $1k moop . So in some areas the CO’s eating a very small moop with partial Medicaid . In most of the country moops avg $7k or more .All regionals who’ve obviously seen the plans are telling me that benefits at best stay the same and some could actually fall this yr .
Tampa is second behind Miami on MAPD low moops. I mostly work Orlando area, Brevard, Port St. Lucie, Stuart, Volusia. They still have great plans but I’m typically doing a UHC HMO $2900 moop no referrals huge nationwide network.
