Help with Low Income/Trial Rights Client

[yorkriver1]

Hi, I am not new to Medicare clients, but am putting much more effort into expanding my client list.
This referral came after the potential client encountered trouble, now I am looking to help for the experience/learning, and to do the right thing, same as I would for friends or family.
She dropped her Medigap plan F at age 80--and has many health conditions--, went to a $0 premium MAPD HMO, then dropped it when she found out how much things would be different. Doesn't want new PCP, didn't like how that went, tried to get another Medigap (interestingly, all 3 carriers involved are ones I write with) and the agent seems to have misunderstood the situation. The original premium quoted was doubled, due to, they said, she has health conditions that require higher premium.
But wait! She's in her 1st year so she has Trial Rights. I read the CMS "Choosing a Medigap Policy" p. 23 very carefully to see how to proceed.
Tomorrow I am going to see her briefly to 1. get a Scope of Appt signed, JIC and 2. to look at her Plan F info, so I can find out if it's the "modernized" version the carrier still sells, or the old, so we know how to proceed. I called, & they will let her switch to the high deductible F, if on the modernized version. If not, she's still free to get a GI plan, since the older one is no longer offered.
Next, at the appointment, 3 days hence, we will consider if she can handle the $55-65/mo of High Deductible F, or if she should go hat in hand to dropped MAPD carrier to see if they'd pick her back up with a PPO since she didn't get the thing properly explained at first. Must be aware of delicacy there...leaning to having her do the Medigap for this year at least.
So, not being so experienced with lower income clients, I see that having a zero premium could be better than $55-65 monthly for Plan F HI-D, since the hospitals might write off any money she owes them? Is this the way to look at it? Real world, what do you all do?
and, new friends, what could go wrong?

 

[Chazm]

If she's used to a regular plan F make sure you fully explain how the High F if different. Don't try to oversell it or it will come back to bite you.

Scope? Don't waste your time unless you are doing a drug plan with it.

 

[BobbyMcGee]

You might want to check her income/assets against the 2013 Financial Eligibility Standards to see if there is a "Dual" there.

 

[billyg]

You might want to check her income/assets against the 2013 Financial Eligibility Standards to see if there is a "Dual" there.

Bingo. Even if it is SLMB (not QMB), that would be $105/mo to go towards a Med Supp. Also, don't forget about LIS. If she qualifies she will save more money there (and also give her an SEP to get back to any MAPD as another option, though the Med Supp will likely be better for her). Of course, if she qualifies as QMB then that would be the best for her.

 

[yorkriver1]

Bingo. Even if it is SLMB (not QMB), that would be $105/mo to go towards a Med Supp. Also, don't forget about LIS. If she qualifies she will save more money there (and also give her an SEP to get back to any MAPD as another option, though the Med Supp will likely be better for her). Of course, if she qualifies as QMB then that would be the best for her.

Update! Went to see her, didn't occur to me that she might have let her Medigap lapse before the end of the year (lapsed in August 2012)oops, plan B...so while checking to see if the MAPD carrier would take her back, eventually it came out that since she's LIS, she could indeed get another MAPD! Can't believe that factoid didn't stick with me from training...dual eligible, got that, sure, but not "extra help" with RX. We high fived, and will put her on an MAPD PPO most likely, don't see where network PFFS would be helpful, unless docs not in network. Good that I did bring an SOA.

She has so much going on medically that Medigap is unlikely, but I will check.

Also, I need to really find out more about the QMB, SLMB, etc. I don't want to leave out the possibility of her qualifying for more help, her budget is so tight. Any suggestions for quick study on those?

Thanks for your responses!
- - - - - - - - - - - - - - - - - -

You might want to check her income/assets against the 2013 Financial Eligibility Standards to see if there is a "Dual" there.

Don't like to seem clueless, but where do I find the 2013 eligibility standards? I definitely want to see she gets all the help available.

Thanks!
- - - - - - - - - - - - - - - - - -

If she's used to a regular plan F make sure you fully explain how the High F if different. Don't try to oversell it or it will come back to bite you.

Scope? Don't waste your time unless you are doing a drug plan with it.

Thanks, good reminder. Turns out she had Plan B, but let it lapse last summer. She is LIS, so now I will do an MAPD, check for further low income help, and double check to see if there is any way to do a med/supp. Too many medical issues, I think.
Much appreciation!

 

[BobbyMcGee]

http://www.dcf.state.fl.us/programs/access/docs/ssi_fin_elig_chart.pdf

 

[yorkriver1]

If she's used to a regular plan F make sure you fully explain how the High F if different. Don't try to oversell it or it will come back to bite you.

Scope? Don't waste your time unless you are doing a drug plan with it.

[/quote] SSI Related Programs chart

Huge help! I will check to see if my client has already got help with Part B premium--she's definitely LIS for RX now. Part B help seems to also be the level for her with about $1,120 monthly Social Security income, sole source. Thanks so much!

 

[BobbyMcGee]

That was the Florida specific chart, of course.

 

[yorkriver1]

That was the Florida specific chart, of course.

Thanks, will look for my state.

 

[xrac]

This forum is a wonderful resources when anyone has a FE or MAPP or Medigap Supp question! We have some real pros on here.