Really Odd Situation Today

[ksigmtsu]

So, I sometimes help people I get off internet leads sign up for QMB subsidies when I can tell from talking to them right off the bat that they probably qualify. The only thing I ask is that they call me whenever they get the letter or call saying it was approved. I explain that once they're approved I can help set up their new policy and be their agent, and about 50% of the time I get a call back, sometimes I don't.

I helped a lady out did all that for her last week, then she called me today. She said medicare was on the other line and they wanted her to sign up for a MA plan with Healthspring but she didn't want to until she had a chance to go over it, and they were saying she had to enroll in it because she needed a medigap policy. She was nearly to the point of tears. They had just approved her QMB extra help app, but at the same time they were trying to force her to enroll in the MA policy.

Does anyone know if the medicare reps are commissioned for signups into MA or Part D plans? What possible recourse would there be toward someone in their office behaving in this manner? Is there any sort of violation going on here, and who would it be reported to?

 

[Thatguy]

it's probably not a Medicare Rep, it's probably an agent telling her that that are with Medicare. They probably said I am calling on behalf of a Medicare Advantage Company, Healthsprings.

 

[insurance0707]

First of all Health springs is a MAPD plan, not a medigap, if they were telling her it's medigap - that sounds fishy. You need to reassure her and put her in what's best for her. Let her know if she's not happy with it, she can make changes anytime she wants because she's getting assistance. If she qualifies for QMB, I think that's full medicaid, if that's the case she'd have Medicare as primary, Medicaid as secondary and than all that's left to get is a PDP plan

 

[billyg]

I explain that once they're approved I can help set up their new policy and be their agent, and about 50% of the time I get a call back, sometimes I don't.

I don't understand. I am still pretty new to Med Supp and MA, so if you can help enlighten me, I would greatly appreciate it. I thought that QMB benefits cover Part B premiums plus essentially whatever Medicare doesn't (kind of like a Med Supp). So what additional insurance would be needed? I have come across several folks in this situation and always passed them by because I thought they didn't need Med Supp. Was I wrong?

 

[jdeasy]

I don't understand. I am still pretty new to Med Supp and MA, so if you can help enlighten me, I would greatly appreciate it. I thought that QMB benefits cover Part B premiums plus essentially whatever Medicare doesn't (kind of like a Med Supp). So what additional insurance would be needed? I have come across several folks in this situation and always passed them by because I thought they didn't need Med Supp. Was I wrong?

There are several layers;

QMB Plus

QMB

SLMB

QI-1

LIS

QMB Plus is always full medicaid. QMB may be, most likely if it's just QMB, they have a Medicaid spend-down.

All levels are based on income. Some pay the part B premium, some pay the part D premium or a portion of it.

It's imperitive to find out which level they are on and what's being paid and not paid.

A person that is not a QMB Plus can benefit in many cases by having a med sup. The problem is, they are getting extra help for a reason, lack of income. Can they afford a med sup?

 

[midwestbroker]

There are all kinds of issues when dealing with QMB's

Part D plans premiums are covered 100% up to a certain point, and that varies per state. Kansas is $36 and change. So, if they choose a plan that is $37, they have to pay the difference.

Medicare Advantage plans may work with QMB's and may not. Missouri did not work with them until a few years ago (Missouri Medicaid said they would not pay co-pays, but they would pay co-insurance and deductibles). Now that has changed and they play nice. Kansas is supposed to work, but seems like if you call 3 different case workers you get 3 different answers.

Once you get the basics down for your state, it is not too bad.

What it really boils down to with most QMB's...what is it going to cost? (They do not want to pay anything) What is it going to do for me?

 

[ILUVSAILZ]

There are several layers;

QMB Plus

QMB

SLMB

QI-1

LIS

QMB Plus is always full medicaid. QMB may be, most likely if it's just QMB, they have a Medicaid spend-down.

All levels are based on income. Some pay the part B premium, some pay the part D premium or a portion of it.

It's imperitive to find out which level they are on and what's being paid and not paid.

A person that is not a QMB Plus can benefit in many cases by having a med sup. The problem is, they are getting extra help for a reason, lack of income. Can they afford a med sup?

You may not realize this in all states but in Colorado the QMB's case worker pushes this coverage through state plans that are so confusing for all of us! I would not hesitate to ask if the plan is a Federal Qualified Health Clinic group- you know the one's that take months to get into appt.? Is Evercare an option here or another private MAPD? I hate the quality of care and providers the FQHC promote. Hope this helps.