Medicaid Ending Question

[kgmom219]

Throwing this out here for discussion.


I know what I am recommending, but want to hear other people's ideas.

Client is losing Medicaid due to PHE. Client makes $2700 per month and has $0 savings. Kidney failure is an issue, as is heart problems and while I don't have a drug list, I do know Eliquis is on it.

Texas. Its GI on Med Supp due to losing Medicaid.

Option 1: MAPD HMO at $0, $3400 OOP
Option 2: MAPD PPO at $0, $6700
Option 3: Plan G/Part D at $175/month
Option 4: Plan N/Part D at $150/month

Assume drug costs are identical. (I don't have the list, so I don't know but will obviously be running it to determine his oop)

 

[DonP]

Plan G .But can he afford it ? If he can’t I’d go with the $3400 Hmo moop. He’s probably one step from eviction. You got to work with what you have

 

[rmhaire]

I'd want to know where the $2700 is coming from. Income, SocSec or both.

Without this, I'd say plan G and if not PPO due to his health conditions.

 

[somarco]

MAPD HMO at $0, $3400 OOP

Will he lose access to his providers if he goes with this HMO? If so, is that a problem for him?

When is his Medicaid going away?

 

[LostDollar]

Caveat, I am NOT an agent and the following is just a personal opinion.

I don't think a wise and considered decision can be made for this issue without knowing

a) the cost of the medications with each of the options

b) how promptly terminal the kidney and heart conditions are considered to be.

(Like if I was in that situation, I might say if I have a life expectancy of less than two years, it probably wouldn't make much difference. If my life expectancy was over two years I might want to give some consideration to whether there was some way I could afford a plan N plus PDP. (And I would have the question, how much are excess charges likely to come into play for kidney and heart conditions?)

From the perspective of the patient, If I was eligible for kidney and heart transplants and there was some financial assistance available for them, I would also be asking my agent which insurance coverage would be best for those.

 

[straightnochaser]

Throwing this out here for discussion.


I know what I am recommending, but want to hear other people's ideas.

Client is losing Medicaid due to PHE. Client makes $2700 per month and has $0 savings. Kidney failure is an issue, as is heart problems and while I don't have a drug list, I do know Eliquis is on it.

Texas. Its GI on Med Supp due to losing Medicaid.

Option 1: MAPD HMO at $0, $3400 OOP
Option 2: MAPD PPO at $0, $6700
Option 3: Plan G/Part D at $175/month
Option 4: Plan N/Part D at $150/month

Assume drug costs are identical. (I don't have the list, so I don't know but will obviously be running it to determine his oop)

Is Plan G available under GI rights? I was under the impression it was A, B, C, F (including Plan F with a high deductible), K, and L.

 

[LostDollar]

Is Plan G available under GI rights? I was under the impression it was A, B, C, F (including Plan F with a high deductible), K, and L.

Caveat NOT an agent.

I think it would have to be for those not eligible for Plan F.

 

[somarco]

Texas. Its GI on Med Supp due to losing Medicaid.

Quoted from the original post for clarification . . .

States and carriers are allowed to offer more liberal options than standard CMS requirements, but cannot be more restrictive.

 

[straightnochaser]

Caveat NOT an agent.

I think it would have to be for those not eligible for Plan F.

Yup, you're correct.

 

[rmhaire]

Is Plan G available under GI rights? I was under the impression it was A, B, C, F (including Plan F with a high deductible), K, and L.

You're correct but you're thinking Federal. Each state has their own rules concerning eligibility. Since she listed G as an option I'm assuming it's available.