Interesting Questions

jolivertexas

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Generally speaking, will Medicaid coordinate with a regular MAPD plan. For instance, will Medicaid pay the copays, deductibles, coinsurances? Will it cover premiums?

Would there ever be any advantage to a fully dual eligible Medicare beneficiary to enroll in a regular MAPD plan if there aren't any special needs plans in area?

Does it generally make more sense for a person to be with original medicare and fee for service medicaid or an SNP?
 
Generally speaking, will Medicaid coordinate with a regular MAPD plan. For instance, will Medicaid pay the copays, deductibles, coinsurances? Will it cover premiums?

Would there ever be any advantage to a fully dual eligible Medicare beneficiary to enroll in a regular MAPD plan if there aren't any special needs plans in area?

Does it generally make more sense for a person to be with original medicare and fee for service medicaid or an SNP?


Good Question. I get referrals from some docs that only accept one MA plan, which is not a D-SNP. When switching them off of a plan that doctor does not take, I've enrolled them on a stand alone PDP and told them that they could use Medicare & Medicaid and instructed them which cards to show and where. I also told them that there are other agents out there who would try to sell them on an MA plan, but not to talk to them since it would remove them from their doctor. After about a year or so, they have called me to ask how they could get glasses covered. So, I put them on the MA plan and instructed them how to use the cards, very specific instructions that I wrote down for them. I hesitated to not put them on an MA, but if I don't do it, some other agent will. It's happened to me in the past. I am in a heavily dominated MA area. If they see a lot of specialists, have a lot of DME or in the middle of home health regimen, please don't do it. warning- They can be high maintenance.

which part of Texas are you in?
 
Generally speaking, will Medicaid coordinate with a regular MAPD plan. For instance, will Medicaid pay the copays, deductibles, coinsurances? Will it cover premiums?

Would there ever be any advantage to a fully dual eligible Medicare beneficiary to enroll in a regular MAPD plan if there aren't any special needs plans in area?

Does it generally make more sense for a person to be with original medicare and fee for service medicaid or an SNP?


Not for a full dual- they need to be on SNPs. For folks that have a share of cost/partial Medicaid some states will pay the co payments etc. of their non SNP MA when it exceeds the monthly share of cost amount set by their states Medicaid just like they would if they had the original type of medicare.
 
if it is a state that pays the cost share then wouldn't a non snp make sense for partial dual eligible. Wont it possibly slow down the spending for the client?
 
if it is a state that pays the cost share then wouldn't a non snp make sense for partial dual eligible. Wont it possibly slow down the spending for the client?






In a perfect world yes it works out good because they essentially retain their monthly share of cost benefit but have better first dollar coverage i.e. 0 PCP co-payment with the MA plan

Of course the share of cost Medicaid is only going to pay if provider bills Medicaid. If they are on a non SNP MA plan share of cost medicaid again doesn't help if network providers don't bill Medicaid.
 
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