Humana VS Aetna

[Jkelzey]

In my area of SC Humana 2025 has made a lot of cost cuts. I have a few duals that are having to pay at specialists. Probably shouldn’t have to pay anything but they’d rather call and yell at me rather call the Dr. I’ve noticed the Medicaid card is often forgotten at new patient appointments. As I am setting up renewals Aetna plans look really good for dual eligibility. I am getting trigger scared though as Aetna has been making a lot of changes. I am worried someone will have Doctor or medication issues. I check and make sure everything is covered but sometimes clients forget to tell me things. Prior authorizations more times than not are a big issue. Thoughts on Humana vs Aetna for 2025?

 

[InsuranceGuy29]

There's really no right or wrong answer. The entire industry is currently experiencing a category 5 hurricane (thanks to this current government administration), and no one really knows what to do.....the companies included.

As far as your dual clients, just always stress to them to make sure they have both of their cards (Medicare and Medicaid), and make sure the doctor takes both of those programs, otherwise they're gonna likely get charged.

You definitely have my sympathies working with duals. Pure chaotic nightmare when I did.

 

[Jkelzey]

There's really no right or wrong answer. The entire industry is currently experiencing a category 5 hurricane (thanks to this current government administration), and no one really knows what to do.....the companies included.

As far as your dual clients, just always stress to them to make sure they have both of their cards (Medicare and Medicaid), and make sure the doctor takes both of those programs, otherwise they're gonna likely get charged.

You definitely have my sympathies working with duals. Pure chaotic nightmare when I did.

That was my initial thoughts! I hope change is coming! This is my 3rd Medicare season and 2025 has me feeling like it’s going to be the best yet [insert sarcasm]

 

[InsuranceGuy29]

That was my initial thoughts! I hope change is coming! This is my 3rd Medicare season and 2025 has me feeling like it’s going to be the best yet [insert sarcasm]

You and me both. I can't take another 4 years of this chaotic insanity. I don't even think any of these plans will be offered in 4 years if Kamala gets in. She will continue passing terrible Medicare policy. And if they are offered, surely none of us will get paid on them. The companies might offer 1 or 2 token policies that are barely profitable and that'll be it. She is terrible for business. Same thing happened with Obamacare and then stabilized once Trump got in, in 2017.

 

[straightnochaser]

In my area of SC Humana 2025 has made a lot of cost cuts. I have a few duals that are having to pay at specialists. Probably shouldn’t have to pay anything but they’d rather call and yell at me rather call the Dr. I’ve noticed the Medicaid card is often forgotten at new patient appointments. As I am setting up renewals Aetna plans look really good for dual eligibility. I am getting trigger scared though as Aetna has been making a lot of changes. I am worried someone will have Doctor or medication issues. I check and make sure everything is covered but sometimes clients forget to tell me things. Prior authorizations more times than not are a big issue. Thoughts on Humana vs Aetna for 2025?

If your duals are being charged copays on a dsnp are you sure they're not partial duals?

 

[annon123]

I am sure you are already doing this but they also need to call billing to get their medicaid card added. If they are getting grief over that and it is a hospital system then they call whatever patient experience/patient advocacy office that system has (hospital systems are required to have one although some are close to useless) to help them deal with this. Tell them that ignoring the bill is a recipe for disaster as many systems, once the bill is sent to collection, will cut off care and/or sue the patient for the bill in collection.

 

[Surancedawg]

An awful lot of the Duals I speak to don't even have an ID card from their state medicaid program. They've called medicaid to get a card, but they never receive them. Even full medicaid beneficiaries. Apparently, some states want to save a few cents by not bothering to print and mail out ID cards. I usually just confirm their medicaid level by running their socials. For the last year, everything about medicaid has been a

 

[annon123]

An awful lot of the Duals I speak to don't even have an ID card from their state medicaid program. They've called medicaid to get a card, but they never receive them. Even full medicaid beneficiaries. Apparently, some states want to save a few cents by not bothering to print and mail out ID cards. I usually just confirm their medicaid level by running their socials. For the last year, everything about medicaid has been a
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They might have to go into the Medicaid office then to get one. Or call and ask to speak to a supervisor. They should have gotten a letter that states they have been awarded Medicaid. If they can find it (and many probably tossed it/can't find it so in the future tell them that may be their only proof, if they have a smart phone take a photo of it, blah blah blah) tell them to show that.

 

[straightnochaser]

They might have to go into the Medicaid office then to get one. Or call and ask to speak to a supervisor. They should have gotten a letter that states they have been awarded Medicaid. If they can find it (and many probably tossed it/can't find it so in the future tell them that may be their only proof, if they have a smart phone take a photo of it, blah blah blah) tell them to show that.

They are on a dsnp - they don't need the medicaid letter or card. My opinion on this is beneficiaries level of medicaid has changed and they're no longer cost-share protected.