Question On Partial Duals

[DonP]

I’ve gotten so many different answers I don’t know what to believe . I’m running into a lot of QI 1’s .The plan says the cost is $0-$29. Taking to the CO’s and regional people I know the premium is waived .Most of the company people have told me drug co pays are $1.80, $3.60 and $9.20 like Medicaid .I know all the partial duals are responsible for the coinsurance and total $7550 out of pocket . Were in very confused is United’s partial dual co/pay for dr’s and specialists is 0-20% . There the only company that doesn’t say like $0 and $15 for co-pays . What do I tell the client there copays are in $ terms ?Has anyone sold ma’s like this ?Any feedback on things I’ve said above appreciated

 

[wehotex]

I’ve gotten so many different answers I don’t know what to believe . I’m running into a lot of QI 1’s .The plan says the cost is $0-$29. Taking to the CO’s and regional people I know the premium is waived .Most of the company people have told me drug co pays are $1.80, $3.60 and $9.20 like Medicaid .I know all the partial duals are responsible for the coinsurance and total $7550 out of pocket . Were in very confused is United’s partial dual co/pay for dr’s and specialists is 0-20% . There the only company that doesn’t say like $0 and $15 for co-pays . What do I tell the client there copays are in $ terms ?Has anyone sold ma’s like this ?Any feedback on things I’ve said above appreciated

Are you sure that that product is suitable for your prospect? Maybe if they were only getting into it for the generous dental benefit? The UHC market that I work in has very minimal copay responsibilities for the Partial Dual on that Dual complete plan, except for the Hosp Part A deductible (that is seldomly billed to the patient here or not the entire amount). The others that stand out are $50 for ambulance, $90 for emergency, $50-100 for drag radiology, etc. In another market that I sometimes dabble in, it is 20% cost share like you describe. My buddy in that market does not push it.
It's my experience that LIS is automatically "deemed" in Texas since the income limits for are lower for the QI-1 and Texas is so damm strict when it comes to the income limits.
When I lived in welfare-crazy California, I once put a Medicare/Medi-Cal "share of cost" person into a HealthNet Partial Dual plan, but her income was TOO HIGH for LIS. So, she had the benefits of being on a Dual plan, but no LIS, which I think resulted in a monthly premium for her? I lost contact with her, but I know that she did not enjoy the LIS amounts on her rx.

 

[DonP]

Thanks for responding . I replaced a regular Ma . I helped her get QI1 with a $60 back on her part B premium . According to Humana who ran her ss # with cms her drug cost is $1.80,$3.60 and $9.20 . From what I understand if your lis they wave the Premiums on partials .Yes she wants the dental but I’m worried about the 20% cost sharing . She was paying 0 and $40 with Aetna . She was also paying $150 a month for drugs . I won’t sell it anymore . Humana’s Partial dual much better as co pays $0 and $15 and no % bs cost sharing . United’s csnp looks strong . Ran into a few

 

[wehotex]

Thanks for responding . I replaced a regular Ma . I helped her get QI1 with a $60 back on her part B premium . According to Humana who ran her ss # with cms her drug cost is $1.80,$3.60 and $9.20 . From what I understand if your lis they wave the Premiums on partials .Yes she wants the dental but I’m worried about the 20% cost sharing . She was paying 0 and $40 with Aetna . She was also paying $150 a month for drugs . I won’t sell it anymore . Humana’s Partial dual much better as co pays $0 and $15 and no % bs cost sharing . United’s csnp looks strong . Ran into a few

In our plans here, a member cannot get a giveback AND be on a Medicare Savings Program. I don't blame you for being a little uneasy. I don't put a lot of people into our Dual plan here, but if I do we are required to tell them that the Hospital could charge them the Part A deductible.

 

[somarco]

@DonP seems like you ask a lot of questions your IMO should be answering.

Just saying . . .

 

[DonP]

Lol my Imo should be answering ? Hell the CO’s and regional directors of the CO’s don’t even know the answers . I was on the phone with regional people from United abd Humana and they don’t know jack shit . I ask questions to learn from people who’ve done it for yrs . It’s complicated shit but I’ll learn it like the back of my hand

 

[somarco]

IMO's and carrier reps are mostly worthless but yet, agents come on here all the time an RAVE about how great they are.

 

[bill3173]

Thanks for responding . I replaced a regular Ma . I helped her get QI1 with a $60 back on her part B premium . According to Humana who ran her ss # with cms her drug cost is $1.80,$3.60 and $9.20 . From what I understand if your lis they wave the Premiums on partials .Yes she wants the dental but I’m worried about the 20% cost sharing . She was paying 0 and $40 with Aetna . She was also paying $150 a month for drugs . I won’t sell it anymore . Humana’s Partial dual much better as co pays $0 and $15 and no % bs cost sharing . United’s csnp looks strong . Ran into a few

If she's a Q1, why is she paying a part b premium?

 

[DonP]

QI is not full Medicaid . It can be the partial return of part B and help with their drugs . Thus the partial dual and not full dull . If they don’t need the dental it seems a csnp is better with some CO’s.

 

[vic120]

IMO's and carrier reps are mostly worthless but yet, agents come on here all the time an RAVE about how great they are.

I look at IMO for commission, Tools, and maybe some lead funding though not the main thing

As far as Info they don't have much other than the stuff I already know