MAPD plan offers electric wheelchair for free

[sam816]

A prospect told me because he has been with his MAPD plan for a long time, they offered a free power wheelchair to him, retail at $3k, for no rent, no coinsurance. I don't know how this can happen, the summary of benefits says 20% for durable medical equipment.

Is this a scam?

 

[vic120]

Is it possible they have Medicaid?

Sometimes I find they don't even know they have it but when they have MA and pay less than $10 for tier 3s and don't have copays listed on SOB then likely they have Medicaid or some other type of assistance.

Sometimes they are paying for stuff they don't realize or because they have not received the bill yet think they don't have a cost-share.

Even find times people think they are paying much less for their supp then they really are because they remember the original price but have not noticed the increases as they don't check their bank deductions

 

[sam816]

He is a retired engineer with decent income and not on medicaid. I thought maybe the wheelchair manufacturer was doing some kind of promotion through the MAPD.

 

[somarco]

https://www.medicare.gov/pubs/pdf/11046-Medicare-Wheelchair-Scooter.pdf

Scooters For Seniors: Does Medicare Pay For My Scooter? (or do I pay?)

Coverage of power wheelchairs and scooters - Medicare Interactive

This is how original Medicare pays. Haven't found anything specific to MA.

 

[MedicareMillionair]

A prospect told me because he has been with his MAPD plan for a long time, they offered a free power wheelchair to him, retail at $3k, for no rent, no coinsurance. I don't know this can happen, the summary of benefits says 20% for durable medical equipment.

Is this a scam?

As you're probably aware, with a prescription, it should be 20% coinsurance. I have found, over the years, that there are exceptions to every rule. I've seen benefits provided that clearly weren't available on a normal basis. I had a client, with Humana MAPD, that had a humana case worker that would do almost anything for him. They clearly went beyond the normal MAPD guidelines to insure this man was receiving any and all medical care and equipment he needed.

Over the years, I've seen this and debated that the benefits weren't available, only to find that I was indeed wrong. There are exceptions. There doesn't seem to be any rational as to who receives these expanded benefits. So, while I would say this person is responsible for the 20%, there's an outside chance he's correct in stating he has zero coinsurance..

 

[sam816]

Maybe this is handled in a way similar to how a car repair shop handles insurance deductible.

20% is what part B pays, so MAPD is not paying anything for the wheelchair, merely a sales conduit to the manufacturer.

Manufacturer is eager to sell to the senior market, so it offers to pay the coinsurance, retail $2500, add some small accessories, sell it for $3000, as long as Medicare accepts the bill.

MAPD can tell the subscriber the wheelchair is free because he has been with them for a long time.

Everybody is happy except the tax payer, but this is not FWA.

 

[somarco]

MA can be more liberal than OM if they want but something about this smells.

Like I tell my clients, if it isn't in writing, preferably in the policy, it may not happen.

Starting to hear grumbling about UHC dropping Silver Sneakers. Wondering when they will drop SS in Georgia.

My response is that SS is not contractual. Neither is the ability to move from one plan to another without underwriting.

 

[sshafran]

MA can be more liberal than OM if they want but something about this smells.

Like I tell my clients, if it isn't in writing, preferably in the policy, it may not happen.

Starting to hear grumbling about UHC dropping Silver Sneakers. Wondering when they will drop SS in Georgia.

My response is that SS is not contractual. Neither is the ability to move from one plan to another without underwriting.

But moving from one plan to another is based on when they enrolled.

If memory serves me right, it was around 2010. People enrolled prior to 2010 did not have that right.

Not sure if it is or isn't guaranteed, but I would not be surprised if it was guaranteed based on enrollment date. I'd have to check into it.

 

[somarco]

There were and still are stipulations on moving from one plan to another . . . if it is still allowed. I know there were some recent changes but since I don't write UHC I haven't kept up.

There are a lot of things done administratively by carriers that are not in the contract. When I wrote Equitable plans one thing nice was how they treated the 30 day grace period (which is contractual). If a premium was late they would switch it to a 90 day plan administratively giving the person extra time to avoid a lapse.

There are also underwriting changes that will happen with some regularity. These changes do not directly impact existing clients until they want to reinstate a lapsed plan or move from one plan to the next (same carrier).

 

[PCBI]

As you're probably aware, with a prescription, it should be 20% coinsurance. I have found, over the years, that there are exceptions to every rule. I've seen benefits provided that clearly weren't available on a normal basis. I had a client, with Humana MAPD, that had a humana case worker that would do almost anything for him. They clearly went beyond the normal MAPD guidelines to insure this man was receiving any and all medical care and equipment he needed.

Over the years, I've seen this and debated that the benefits weren't available, only to find that I was indeed wrong. There are exceptions. There doesn't seem to be any rational as to who receives these expanded benefits. So, while I would say this person is responsible for the 20%, there's an outside chance he's correct in stating he has zero coinsurance..

Partiality