Need Some Other Minds on this

Jul 7, 2015

  1. G.Gordon
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    G.Gordon Guru

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    Beneficiary on due to disability since early 2007.

    Sounds like she's been on various Medicare advantage plans, etc. trying to find the best fit for her mental health provider that really works well for her.

    Confirmed that she is on Medicaid with a $285/mo spend down.

    She currently has Humana PFFS and Humana WM Pref. PDP. effect 5/1 after a call to Humana.

    Is there any way to get her off the PFFS before AEP rolls around.

    Her doctor's office confirmed that they'd rather she was on straight Medicare, I agree due to low spend down and the fact that Missouri Medicaid does not coordinate with Medicare Advantage at all.
     
  2. healther
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    healther Guru

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    Request a cancellation from Medicare.
     
  3. G.Gordon
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    G.Gordon Guru

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    I know you can SEP a person for "drug" coverage changes, but can you do that for a MA only when that cancellation will not be effecting her drug coverage?

    We pull the LIS SEP all the time, but never in a combo enrolled person like this.
     
  4. TwoCents
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    In CMS eyes there's actually a distinction between LIS and Full Duals (Medicaid). A full-dual can leave an MA-only plan while technically those with only LIS would not (their election lets them leave a Part D plan -- MAPD or PDP).

    So either call Medicare to disenroll from the PFFS or write a carefully worded letter to Humana saying that she has Medicaid and wants to disnroll from the PFFS (include the contract-pbp) only for the next available term date. If the letter is received in July then she'd be termed 7/31 of course.
     
  5. G.Gordon
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    G.Gordon Guru

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    Great, not getting me a new client, but getting a person the best outcome possible is what generates referrals. We don't deal with too many of the duals and I don't guess I have ever ran into one with MA and PDP that needed anything.
     
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