Help Advising this Client?

[axeman462]

Recently had a referral for a lady who is Medi/Medi. An agent last year put her on Humana PPO even though she is Medi/Medi, and the out of pocket costs is killing her.

She has parkisons, and some rather expensive drugs, and really really wants to keep her doctor. Her doctor only accepts a couple Dual MAPDs. And with all the Duals available in my county, I keep running into the same problems; either not all her drugs are covered, or the doctors doesn't accept that company.

I'm thinking maybe the best thing for her to do, would be to drop the Humana PPO, and do original Medicare with Medicaid, and pick up a Pt D plan? Would this be the best thing for her situation? I cant imagine staying with the PPO would be better. suggestions, ideas?

 

[cadylou]

Recently had a referral for a lady who is Medi/Medi. An agent last year put her on Humana PPO even though she is Medi/Medi, and the out of pocket costs is killing her.

She has parkisons, and some rather expensive drugs, and really really wants to keep her doctor. Her doctor only accepts a couple Dual MAPDs. And with all the Duals available in my county, I keep running into the same problems; either not all her drugs are covered, or the doctors doesn't accept that company.

I'm thinking maybe the best thing for her to do, would be to drop the Humana PPO, and do original Medicare with Medicaid, and pick up a Pt D plan? Would this be the best thing for her situation? I cant imagine staying with the PPO would be better. suggestions, ideas?

Depending on what drugs she's taking, that strategy may be better for her with a disease like Parkinsons. It will all depend on the cost of various PDP plans that would cover any specialty drugs she may take. You'd have to do the overall math with drug co-pays included to determine the net effect.

MAPD drug plan components aren't geared for the person with a serious condition - they usually cover the top 200 drugs that most people take - or some variation on that theme. Often specialty drugs & expensive brand names, if required, can be problematic.

 

[axeman462]

Depending on what drugs she's taking, that strategy may be better for her with a disease like Parkinsons. It will all depend on the cost of various PDP plans that would cover any specialty drugs she may take. You'd have to do the overall math with drug co-pays included to determine the net effect.

MAPD drug plan components aren't geared for the person with a serious condition - they usually cover the top 200 drugs that most people take - or some variation on that theme. Often specialty drugs & expensive brand names, if required, can be problematic.

so, if I put her on a PDP plan that covers all her prescriptions, that would automatically knock her off the PPO right? And I can do this mid-year, we dont have to wait for AEP right?

 

[vic120]

so, if I put her on a PDP plan that covers all her prescriptions, that would automatically knock her off the PPO right? And I can do this mid-year, we dont have to wait for AEP right?

Correct, Having any state assistance medicaid or just PDP help will allow her to make a change now