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Medicare+Medicaid??
- Thread starter New kid
- Start date
- 527
- Thread starter
- #13
I am asking a general question. Some of my clients do not have any chronic conditions, only Medicare and Medicaid
In Georgia I believe the % of PCP's that accept Medicaid patients is less than 40%. Probably not much different in other states.
According to KFF 96% of PCP's accept original Medicare. There may be a waiting list for some docs if you are a new patient, but I have not had clients say they could not find a doc who takes original Medicare. This includes clients that did not have a PCP prior to age 65.
More rejection problems with MA plans. Not all docs take them. Some will take BX but not Aetna or vice versa. There are also parts of the state where hospitals only accept a limited number of MA plans. And areas where the number of specialists that participate in MA plans is limited.
My PCP has a list of insurance and non-insurance plans they will not take.
Many cancer treatment centers like do not accept any MA plans.
According to KFF 96% of PCP's accept original Medicare. There may be a waiting list for some docs if you are a new patient, but I have not had clients say they could not find a doc who takes original Medicare. This includes clients that did not have a PCP prior to age 65.
More rejection problems with MA plans. Not all docs take them. Some will take BX but not Aetna or vice versa. There are also parts of the state where hospitals only accept a limited number of MA plans. And areas where the number of specialists that participate in MA plans is limited.
My PCP has a list of insurance and non-insurance plans they will not take.
Many cancer treatment centers like do not accept any MA plans.
I’m not sure why chronic conditions would matter if they are dual eligible.
Can you put them in a dual MAPD? If not, just move on. No reason to waste your time.
Family Man
Expert
- 48
My book of business resides in mostly rural communities throughout northern Indiana and haven't had an issue with Medicare acceptance. Dual eligible policyholders some times want the option of a non Medicaid provider that will accept an insurance plan instead. I would recommend to know, to the best of your ability, the specific provider's billing on this matter.
- 289
True, and part of the reason has been stated before...but for the sake of redundancy, the reason is that the plans shave more off the bone from service providers. As much as we all like to think that Dr's, generally speaking, are altruistic and benevolent, the reality is that most want to maximize their incomes.
On the question of whether or not the PCP or service providers in general accept Medicare and/or Medicaid, I've run across many that prefer dealing with Medicare and or Medicaid directly vs someone who's is in a DSNP.
So, I've left some prospects on straight Medicare/Medicaid, when their preferred PCP or Specialist didn't accept the "best" plan for their patient, and the patient/prospect was not willing to switch Dr's.
Sure about that?
My doctor is in 34761, Scott Marsel. He takes uhc HMO/PPO but does not take the dual plan.
Check out the directory here for dual plans. https://www.uhccommunityplan.com/as...BrevardFlaglerIndianRiver-R7444-012-PD-EN.pdf
It’s a different directory.
Let me know but any meeting I’ve been to just says the HMO and PPO have the same network. Their DSNP has had a separate network since I’ve been in the biz
Whoops missed this. I question that %. I mean, I looked up my Dr. first and he didn’t take the SNP. Sounds like UHC not knowing their product.
