Does "Full Dual Eligible" Always Mean A Client Has Full Medicaid?

[DGoldberg]

humana for sure, probably uhc. Just want to have the client write in their OWN HANDWRITING:
date:
"Please have john doe be my agent of record effective immediately." print name
sign name

then you write out:

Humana ID #
DOB
Zip code
Agent name
SAN#

Some carriers will allow this but unfortunately UHC will not recognize any AoR changes unless a new plan is written.

 

[jemelton]

If someone is on medicaid in a rural county with no dual eligible MA plans available there isnt anything you can do to help them obviously is there?

 

[wallstwizard]

It’s not necessary no. In Louisiana for example we have a plan throughout state with one carrier, that can be bought for like $37 a month for someone on Medicare only that does have co-pays, but you can enroll dual eligible in it too, and they have no premium and no co-pays or out of pocket costs. On the membership card it has two columns, one with co pays and one without. I would call the companies and ask them about that.

 

[springbokhouston]

Some states also have Care Improvement Plus Dual plans with statewide dual coverage. Not as generous as the dual HMO plans in many metro areas but a great network addition for someone on Medicaid alone. UHC specifically teaches that you cannot affect someone's Medicaid benefits (at least that's what they teach in TX), therefore the beneficiary can continue to use their Medicaid card as well as access the benefits of the new network.

 

[springbokhouston]

I also don't know why you wouldn't offer a standard MAPD to someone in a rural area that only has Medicaid? I have met with multiple carriers in multiple states that specifically push this in areas where they don't have a SNP plan. Giving a beneficiary access to a huge network is a major plus in my book and lot's of plan premiums are based on the Part D portion anyway. If they are eligible I would offer it to them.

Federal law (Sections 1902(n)(3)(B) and 1866(a)(1)(A) of the Act, as modified by Section 4714 of the Balanced Budget Act of 1997) prohibits all Medicare providers from billing QMB individuals for all Medicare deductibles, coinsurance, or copayments.

 

[jemelton]

If someone is already on Medicaid could you enroll them in a regular non dual eligible plan mid year or would you have to apply during open enrollment. If they are already on Medicaid they dont apply for extra help and create a sep, right?

 

[RunnerDude]

Hey Boss, this is what you need to do. Been working duals hard for about 6 1/2 years. On Humana generally, and they can tell you if you call Agent support for dual eligible check, they will either need qmb, qmb+, or slmb+, although all states don’t have slmb+. I’m betting this person you met with recently went on Medicare from Medicaid, , and the state did not automatically put them on qmb. They still have no out of pocket costs with that status, but probably won’t qualify for the desnp plan. Solution...fill out a new medicare savings application with your state and submit, within a matter of a few weeks they will get a qmb letter, then you can enroll. The new income requirement in most states for qmb is now $1,034...good luck, but that will solve it.

 

[RunnerDude]

Thanks for the information. I was wondering- what have you found to be the best lead source for finding potential Dual eligible clients (without breaking the bank)? My goal is to amass at least 1,000 clients on MAPD's in the next 4 to 5 years.

 

[springbokhouston]

If someone is already on Medicaid could you enroll them in a regular non dual eligible plan mid year or would you have to apply during open enrollment. If they are already on Medicaid they dont apply for extra help and create a sep, right?

If they have any level of Medicaid they have a year round SEP

 

[springbokhouston]

Thanks for the information. I was wondering- what have you found to be the best lead source for finding potential Dual eligible clients (without breaking the bank)? My goal is to amass at least 1,000 clients on MAPD's in the next 4 to 5 years.

Run Final Expense leads. I train our people to sell compliantly year round using SEPS. Most FE clients are eligible for extra help and you will also sell more standard MAPD which is stickier than DSNPs. Besides you also should close 20% or more of the FE leads and easily pay the lead cost and make plenty of extra money while you’re building your Medicare book.