MAPD Client Now Gets Medicaid

Nov 5, 2015

  1. karaboo
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    Rookie question here: I enrolled a woman last year into a Humana MAPD in Cook County, Illinois (aka "Crook" County) ;). Anyway, over the many months of 2015, she quit her part time job and now is enrolled in Medicaid. According to her daughter, Medicaid is paying her Medicare Part B premiums.
    My understanding is that she now automatically qualifies for "Extra Help" with her drugs. If so, what happens to her existing Humana MAPD plan? The Humana MAPD drug copays no longer align with the Extra Help guidelines of $2.95 for generic and $7.40 brand-name drugs. Any insights? Thanks
     
    karaboo, Nov 5, 2015
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  2. GoPokes
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    Umm, I think her Bumana monthly premium will go down by about $30/mo. Her new copays will be 2.95-7.40 regardless of who her drug coverage is with (stand alone pdp or mapd), assuming the drug she needs is on the formulary. So, that means if she keeps the bumana, she will pay these new standardized LIS copay amounts. Also, if she had an annual Rx deductible, she will no longer have it.

    If ive missed something here, Im sure somebody will chime in and correct me.
     
    GoPokes, Nov 5, 2015
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  3. Chazm
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    He said she's on a MAPD plan. I'm assuming the plan is already zero.

    She can stay on that plan and her part B premium is paid if she's QI1 and up. If the MAPD plan has $0 generics she will pay zero. But if it's more than the Lis then it'll be the LIS price.

    If you have a good Medicaid plan available it'll benefit her to go on that plan instead.
     
    Chazm, Nov 5, 2015
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  4. yogooglethis
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    she now also qualifies for free cellaphone service
     
  5. Team Manning
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    Yes, see if there is a DSNP plan available, but she must be FULL BENEFIT Medicaid. Otherwise, if she has a spenddown, keep her on the MAPD
     
  6. Chazm
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    Not always true. In FL there are plenty of partial Medicaid plans. But I'm not sure about his area
     
    Chazm, Nov 6, 2015
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  7. kamp
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    Almost all MA plans will coordinate with partial Dual's in MO. One thing that is important to understand here, and you already said it, is that everyone lives in different parts of the country and things can be wildly different.
     
    kamp, Nov 6, 2015
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  8. Chazm
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    I mean we actually have partial Medicaid plans that have pretty much everything at a $0 cost straight down. So if someone has partial Medicaid and gets a regular MAPD plan you're saying it's all $0 too? Did not know that
     
    Chazm, Nov 6, 2015
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  9. kamp
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    No, we don't. So, even those with a spend down, they have plans like that where you are and the SD doesn't have to be met?
     
    kamp, Nov 6, 2015
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  10. G.Gordon
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    Missouri Medicaid DOES NOT COORDINATE with any MAPD other than full dual plans. If a person has a small spend down (less than $300) they are better off staying on Medicare and Medicaid in Missouri. I can't stand agents that run around slapping people in senior housing on MAPDs and then don't service the problems created.
     
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