MA Plan : Hitting the "donut Hole" Now: Insulin Diabetic: Can She Save $$

[CALTCAgent]

I will preface this as I am not a MA guy, FMO & carrier not much help at this stage. I also realize I don 't have all the exact numbers.

F, 61-On S. S. disability and an MA plan, $96 mo, and it appears from medicare.gov, $200 co-pay Hospital 1-8 days, $5,000 MOOP. Not sure if it is a Chronic SNP or not.

She asks me if she can save money on her Rx's as she is hitting the donut hole in August. Her insulin comes in a box $400 a box, 3ml, 100 units per "pen".

I ran the insulin stuff on medicare, the site listed her MA plan as the best and at $0 drug costs. I didn't put the exact amount, just chose something as I didn't ask her exact amounts. I also didn't put all the drugs.

Should I look at Chronic SNP plans for diabetics ?

Med supp & part D whenever she can qualify without underwriting ?

I talked to another Chronic SNP Diabetic plan and they said there is a "flexpen", and they don't cover that. If she just takes the "shots", that would be covered at no cost.

So I am assuming she must be taking this "flexpen" ?

Is this typicaly not covered by MA and/or MA SNP Plans ?

Do some standalone part D plans cover the "flexpen" ?

Any helpful advice, suggestions, so I can assist her in knowing if she has the best plan for her would be appreciated.

PM me direct if you prefer.

She takes:

Insulin 38 unites a day
Uses a "flexpen", I believe that is what it was called.
Metformin -oral for diabetes
Losartan- HBP
Metoprolol - HBP
Amlodipine -HBP
Simvastatin - Cholesterol

 

[GreenSky]

No, you shouldn't look at a C-SNP. You should refer this to an agent that actually works this market.

If she can qualify for Health Net's Jade then that's the plan for her.

But for any agent to "play" in this market without knowing what they're doing is setting up both the agent and client for problems.

Rick

 

[kstein]

What state? Maybe SPAP or LIS?

 

[CALTCAgent]

No, you shouldn't look at a C-SNP. You should refer this to an agent that actually works this market.

Where would you find a person like this ?

If she can qualify for Health Net's Jade then that's the plan for her.

Interesting. Thanks you.

But for any agent to "play" in this market without knowing what they're doing is setting up both the agent and client for problems.
Rick

Who is playing ?

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What state? Maybe SPAP or LIS?

I think she is going to be slightly above the LIS limits. Not by very much. Has about 15 to 20k in a qualified account I believe.

 

[Piece Of The Pie]

See if the Diabetic SNP from SCAN is in her county. It covers insulin thru the donut hole.

 

[fleur]

See if the Diabetic SNP from SCAN is in her county. It covers insulin thru the donut hole.

SCAN is no longer paying initial commissions on the Balance plan in Riverside/San Bernardino counties as of Jul. 31st and renewals will stop in December.
Have not received word on status in other counties where offered.
Heart plan is not affected.

As Greensky said.....check out HN Jade.

 

[CALTCAgent]

See if the Diabetic SNP from SCAN is in her county. It covers insulin thru the donut hole.

She has SCAN. Not sure if it was the diabetic plan. I guess it is not as she was saying she hit the donut hole the last few years.

I think it is this "flexpen" that is expensive and/or not covered ?

I was told by Caremore is she switches to the syringes, it would be covered.

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As Greensky said.....check out HN Jade.

Do you know what counties Jade is in ? I didn't see it listed on medicare.gov, and I am still looking on the healthnet site.

 

[Newby]

I will preface this as I am not a MA guy, FMO & carrier not much help at this stage. I also realize I don 't have all the exact numbers. F, 61-On S. S. disability and an MA plan, $96 mo, and it appears from medicare.gov, $200 co-pay Hospital 1-8 days, $5,000 MOOP. Not sure if it is a Chronic SNP or not. She asks me if she can save money on her Rx's as she is hitting the donut hole in August. Her insulin comes in a box $400 a box, 3ml, 100 units per "pen". I ran the insulin stuff on medicare, the site listed her MA plan as the best and at $0 drug costs. I didn't put the exact amount, just chose something as I didn't ask her exact amounts. I also didn't put all the drugs. Should I look at Chronic SNP plans for diabetics ? Med supp & part D whenever she can qualify without underwriting ? I talked to another Chronic SNP Diabetic plan and they said there is a "flexpen", and they don't cover that. If she just takes the "shots", that would be covered at no cost. So I am assuming she must be taking this "flexpen" ? Is this typicaly not covered by MA and/or MA SNP Plans ? Do some standalone part D plans cover the "flexpen" ? Any helpful advice, suggestions, so I can assist her in knowing if she has the best plan for her would be appreciated. PM me direct if you prefer. She takes: Insulin 38 unites a day Uses a "flexpen", I believe that is what it was called. Metformin -oral for diabetes Losartan- HBP Metoprolol - HBP Amlodipine -HBP Simvastatin - Cholesterol

The first thing you have to learn is to never use the word "best". That is a banned word by CMS.

I'm not joking or exaggerating. That will be on your compliance test several times. Any use of the word best is non-compliant.

You can say it appears to be a good choice for you.

 

[goget]

caltc what type of insurance do you sell?You ask the same questions in the fe forum not ever knowing which company to use and same thing with med sups.Its like you're not in either mkt

 

[GreenSky]

caltc what type of insurance do you sell?You ask the same questions in the fe forum not ever knowing which company to use and same thing with med sups.Its like you're not in either mkt

Hence my point about "playing."

Rick