Medicaid Spendown Costing More Than a Plan F! Any GI or SEP?

[MedicareMegan]

I have an 86 year old prospect in Missouri whose daughter called to tell me was losing her Medicaid. She has been covered under A and B for some time now. Then I spoke with her daughter a second time, and she said that her mom wasn't losing it entirely, but Medicaid increased her spend down to $900/month PLUS they were no longer going to cover her part b premium. This is going to put her mom paying well over a thousand dollars a month for Medicaid (Much more than a supp+part b+ a drug plan.) I know for a MAPD one of the special election periods is being "no longer eligible for Medicaid." (Technically she's still eligible-just at an outrageous spend down.) I'm assuming at 86 she will not pass Medical UW for a supp. Are there any loopholes here for this complicated situation?

 

[Chazm]

Do you mean her SOC share of cost is $900? If so that doesn't mean it cost her $900/month

 

[G.Gordon]

Yes, she is eligible for a SEP for MAPD. But, the spend down only applies in months when she has medical or prescription expenses. Most months she will not meet the spend down.

 

[MedicareMegan]

Thanks so much for the helpful responses. Rookie mistake that it took me having to call Medicaid this morning for me to truly understand the dynamics of a costly spendown. That is still a pretty high spendown (Even if she doesn't meet it), and I am figuring now that she should keep her Medicaid and Dually enroll in an MAPD to possibly lower her $900 spend down with additional insurance.She will have an SEP for being on Medicaid. This way she can keep her LTC that Medicaid pays for. Would there be any downsides to this?

 

[G.Gordon]

Are you in KC area? North of the river?

 

[yogooglethis]

Thanks so much for the helpful responses. Rookie mistake that it took me having to call Medicaid this morning for me to truly understand the dynamics of a costly spendown. That is still a pretty high spendown (Even if she doesn't meet it), and I am figuring now that she should keep her Medicaid and Dually enroll in an MAPD to possibly lower her $900 spend down with additional insurance.She will have an SEP for being on Medicaid. This way she can keep her LTC that Medicaid pays for. Would there be any downsides to this?

Would there be any downsides to this?[/QUOTE]

-network

- sometimes the specialist MA co pay may seem high to a person like this who is only paying 20%

-- MA hospital copays that would always be covered by her 900.00 SOC.Technically she could still submit MA copays to state medicaid but in the real world that doesn't always go smoothly

 

[G.Gordon]

Been in the business for a while? Seems like you're missing some important information. Select quote didn't teach you much.

Learning first had from an expert wasn't interesting to you either...

 

[MedicareMegan]

Last I checked you are also on a senior insurance forum where questions are either answered or asked. Being green doesn't mean being dumb. That's why I'm asking. To answer your question, no, they did not teach me about the spend down in detail. I would much prefer not "learning from an expert" over having to go to a hotel in Columbia with "the expert" to learn it- unpaid might I add

 

[kennethbroyles]

Last I checked you are also on a senior insurance forum where questions are either answered or asked. Being green doesn't mean being dumb. That's why I'm asking. To answer your question, no, they did not teach me about the spend down in detail. I would much prefer not "learning from an expert" over having to go to a hotel in Columbia with "the expert" to learn it- unpaid might I add

Sorry Megan; It's often very challenging getting help here anymore.

 

[MedicareMegan]

Thanks for your sympathy lol