MA dual eligibility - being pitched

[Frank Stastny]

Great question Frank. Now a rebuttal to the agents who have sold these types of plans before from the consumer side assuming the HMO plan has a good network.


"Checking out the network", isn't nearly as important for a person on Medicaid as it is for a person on Medicare. Medicaid patients are severly limited to access to doctors.

How is signing up people for a dual eligible plan going to benefit a member by having more options to doctors, as well as the availability of quality health care vs. what they currently have now. In other words, are the medi-medi members limited by certain limitations I;m know aware of right now?

There are fewer and fewer doctors who will accept a Medicaid patient. I'm not sure what you mean by "medi-medi" members. I have never heard that before so I don't have a clue what you are talking about. People are either on Medicare or they are on Medicaid.

People on Medicaid who go with an HMO have a much larger pool of doctors to choose from. Thus giving them more options and improved health care.

The main advantages I see thus far, w/out knowing more information yet, is that the dual-eligibles can take greater pride in having their own doctor/health plan and not have the stigma attached to being a medicaid recipient. Same thing pretty much, but a different way of looking at things.

It has nothing to do with the "stigma attached". It has to do with more options.

Secondly, If the networks check out that's a plus.

Again, don't think of terms of a network, people on Medicaid really don't have any kind of network.

Lastly, the plans themselves may offer more benefits than what they currently are getting. Thoughts????

No, there use to be more benefits offered to people on Medicaid. Glasses, dental, free drugs, etc. Free drugs were taken away from them when Part D was introduced.

Today, a person on Medicaid I believe is much better off going with an HMO.[/quote]

I only added this because the message said my post was too short.

 

[Frank Stastny]

Oh, and for what it's worth my father thinks Medicare in general sucks. Finding a doctor is harder and harder and he thinks the care as compared to when he had coverage through General Electric is horrible. As it stands now he drives 40 minutes to see his doctor.

I am really surprised. I have never heard of anyone telling me that they encountered a doctor who would not accept a patient who was on Medicare. Nor have I ever had an agent working in the senior market in any state tell me that their clients were having difficulty finding a doctor who will take a patient on Medicare.

Many of my clients travel extensively and with Medicare and a Medicare Supplement policy they have never had a problem going to a doctor in whatever state and town they have been in.

I sure would be interested in getting more information about what your father said. Something just doesn't sound right.

My wife, Jacqueline, works with doctors all over the United States and she has never encountered a doctor who will not accept patients who are on Medicare.

 

[GreenSky]

What everyone is missing is unlike the straight Medicare patient, a dual eligible can change his plan on a monthly basis...and they do.

The hardest part of working with Medi-Medi's is that they tend to disenroll quickly. Most plans charge back if they leave within 90 days.

Lastly, HMOs are supposed to save Medicare money. Assuming this is true (yes, a big assumption), then shouldn't ALL people who are receiving truly fee coverage be in HMOs?

Rick

 

[Frank Stastny]

Lastly, HMOs are supposed to save Medicare money. Assuming this is true (yes, a big assumption), then shouldn't ALL people who are receiving truly fee coverage be in HMOs?

Rick

It would give those people receiving "fee coverage"? a much more secure option than those who opt for a PFFS plan. (I assume you ment "free" coverage, am I wrong?)

At least people with an HMO know who they can and can't go to. Not so with those who choose a PFFS plan.

 

[Frank Stastny]

Oh, and for what it's worth my father thinks Medicare in general sucks. Finding a doctor is harder and harder and he thinks the care as compared to when he had coverage through General Electric is horrible. As it stands now he drives 40 minutes to see his doctor.

John, I have had a few people tell me that there are doctors who "don't accept Medicare" when they really mean that the doctor does not Accept Assignment. That doesn't mean that the doctor doesn't take Medicare though.

It simply means that the doctor isn't willing to accept the amount that Medicare approves. In the early 90's this was a major problem, but since Medicare made drastic changes in the Medicare rules and regs it really isn't that significant whether or not a doctor Accepts Assignment.

It is very rare today to find doctors who do not Accept Assignment but there still those few that are still "hold outs".

Is it possible that is what your father was referring to? If so, someone needs to explain the changes that were made in the mid 90's.

 

[senior-advisor-indiana]

I know 1 that doesn't accept assignment. I think it is more common with chiropractors also.

 

[policy doctor]

I remember posting this several months ago that some doctors in Atlanta do not accept Medicare assignment.

One is a rheumatologist that coincidentally 2 of my friends went to.

Again, that is a specialty and he has a thriving well renowned practice.

I have always heard that anesthiesiologists charge the full price. I bet those specialty clinics like MD Anderson, Mayo, Sloan-Kettering have their higher expectations too. Medicare works with "approved charges" not the total bill. Kinda like UCR.

A Med Advantage client may not get the pre-approval from these places. Because once they start treating him they cannot balance bill, and must accept what the MA plan pays(Medicare substitute) + the patient pays his co-pay am't.

Medi-Medi means Medicare/Medicaid combination, or dual-eligible. Capisch?
Medicaid is like a trump card....First Medicare pays their share, then the state (Medicaid).. But how much do they pay? AHHHHHHhh depends on the level of Medicaid assistance they qualified to get. Their co-pays vary from Zero to $5 for some meds, and dr gets 5-10 per visit, or nothing if they are destitute.

Enuf said.

 

[Frank Stastny]

I remember posting this several months ago that some doctors in Atlanta do not accept Medicare assignment.

One is a rheumatologist that coincidentally 2 of my friends went to.

Again, that is a specialty and he has a thriving well renowned practice.

I have always heard that anesthiesiologists charge the full price. I bet those specialty clinics like MD Anderson, Mayo, Sloan-Kettering have their higher expectations too. Medicare works with "approved charges" not the total bill. Kinda like UCR.

A Med Advantage client may not get the pre-approval from these places. Because once they start treating him they cannot balance bill, and must accept what the MA plan pays(Medicare substitute) + the patient pays his co-pay am't.

Medi-Medi means Medicare/Medicaid combination, or dual-eligible. Capisch?
Medicaid is like a trump card....First Medicare pays their share, then the state (Medicaid).. But how much do they pay? AHHHHHHhh depends on the level of Medicaid assistance they qualified to get. Their co-pays vary from Zero to $5 for some meds, and dr gets 5-10 per visit, or nothing if they are destitute.

Enuf said.

There are some doctors everywhere who still refuse to accept assignment. Midwestbroker said he knows of one in the KC area, I know of two in St. Louis. I sell insurance all over the state of Missouri. That is a total of three doctors that he and I know of. You know of one in the Atlanta area. I have been in he senior market for 14 years. I would not call that even a small number of doctors who do not accept assignment.

You said "I have always heard that anesthiesiologists charge the full price". Who have you heard that from and what do you call "full price". If a doctor does not accept Medicare Assignment, that doctor is only permitted by Federal Law to add 15% to the amount that Medicare approves. However, it doesn't end up being a full 15% because for doctors who do not Accept Assignment, Medicare reduces the amount they would normally approve by 5%.

 

[midwestbroker]

Finding a doctor that does not accept Medicare is rare. Sure they are out there, but they are few in #'s in compared to the rest of the docs out there.

On the other side of the coin to doctors accepting, some will not charge the patient the 20%.

I know a chiropractor who said that Medicare pays about $19 per adjustment. The practice charges $45 normally. If a Medicare bene comes in, they write off the 20% as a loss. However, normally, the patient is happy and wants regular adjustments. So, now they have a new patient they see 2x's per month (Medicare allows for 24 adjustments per year), and it does not cost the client anything.

 

[Frank Stastny]

Finding a doctor that does not accept Medicare is rare. Sure they are out there, but they are few in #'s in compared to the rest of the docs out there.

On the other side of the coin to doctors accepting, some will not charge the patient the 20%.

Mike, do you know of any doctors in KC who refuse to take patients who are on Medicare?