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I HAVE MUCH TO SAY ON THIS but will try to be as succinct as I can being that I have worked VERY EXTENSIVELY with duals and have cleaned up MANY MESSES that other scum bag (that's right) scum bag agents have created for these folks.
The duals are a special population. Okay. Some have scamed the system while many many have not. They don't have much and all they have our those benefits and you as an agent. A lot of these people do not even have family or friends. These PFFS plans are not all structured to coordinate with the state and each state operates differently, as Midwest pointed out. Bottom Line: do your homework! Good job Mary for trying to help this lady.
I know where I reside, Humana on their Gold plan did take the duals the first year here when Part D exploded; but after the after math of not being able to get billing right and coordination with the state, it's a well known fact, here, where I live Humana, does not want them anymore ! But you have those deceptive, soul-less filthy agents who lie and hurt them and still write Humana Gold. If a company offering MA PFFS does not coordinate with the duals, it will HURT their Medicaid and in some cases, dismiss it! So then, those duals will be held accountable for those copays and most bring in less than 700 bucks a month! Some less. And some bring in a little bit more but rarely over a grand. This is where the SNP program comes into play and Wellcare. Though Wellcare is not a SNP, they still work with duals. But understanding the duals, and the different levels, is where the fun comes to play when you do work with a carrier that does coordinate with the state like Evercare, Molina, Midwest, and a few other companies. These programs work best with Medi Medis.
If a dual is on a spend down (a PFFS dual or SNP product ) a PFFS can greatly hinder their benefits too. And you do not always know if they have a spend down but most duals know if they do. Some, however, don't. So you as an agent have some leg work to do buy trying to call their case worker (good luck with hearing back in a timely fashion) to make the deal happen. Also, it is important knowing that certain stand alone PDPs will only coordinate with duals and not all of them will. And if they don't coordinate, that can hurt a dual's benefits too. For example, Advantra Rx does not on the PFFS or PDP side. The key is to inform these beneficiaries and make them understand that their medicaid will not be hindered as long as they accept a program that coordinates with the state. And they must go and see docs who take medicare, mediciad, and the snp or dual product because their current clinics or docs may not, -just like any insurance program. They know if they see docs who don't take medicaid they will have to pay; hence this is why they go to clinics. These PFFS plans are created to provide better health care with extra added benefits in real doc's offices (b/c many of these clinics are practiced by residents. ewww).
As a professional agent, you can be held 'liable.' Mary good luck with that case.
If any of you have any questions on duals, let me know. I am very VERY excited to sell Evercare. It's not available in my home state yet but am looking forward to this 'give' away product being where I live, so many are on Medicaid and hoping it will be available for me to represent next year.
The duals are a special population. Okay. Some have scamed the system while many many have not. They don't have much and all they have our those benefits and you as an agent. A lot of these people do not even have family or friends. These PFFS plans are not all structured to coordinate with the state and each state operates differently, as Midwest pointed out. Bottom Line: do your homework! Good job Mary for trying to help this lady.
I know where I reside, Humana on their Gold plan did take the duals the first year here when Part D exploded; but after the after math of not being able to get billing right and coordination with the state, it's a well known fact, here, where I live Humana, does not want them anymore ! But you have those deceptive, soul-less filthy agents who lie and hurt them and still write Humana Gold. If a company offering MA PFFS does not coordinate with the duals, it will HURT their Medicaid and in some cases, dismiss it! So then, those duals will be held accountable for those copays and most bring in less than 700 bucks a month! Some less. And some bring in a little bit more but rarely over a grand. This is where the SNP program comes into play and Wellcare. Though Wellcare is not a SNP, they still work with duals. But understanding the duals, and the different levels, is where the fun comes to play when you do work with a carrier that does coordinate with the state like Evercare, Molina, Midwest, and a few other companies. These programs work best with Medi Medis.
If a dual is on a spend down (a PFFS dual or SNP product ) a PFFS can greatly hinder their benefits too. And you do not always know if they have a spend down but most duals know if they do. Some, however, don't. So you as an agent have some leg work to do buy trying to call their case worker (good luck with hearing back in a timely fashion) to make the deal happen. Also, it is important knowing that certain stand alone PDPs will only coordinate with duals and not all of them will. And if they don't coordinate, that can hurt a dual's benefits too. For example, Advantra Rx does not on the PFFS or PDP side. The key is to inform these beneficiaries and make them understand that their medicaid will not be hindered as long as they accept a program that coordinates with the state. And they must go and see docs who take medicare, mediciad, and the snp or dual product because their current clinics or docs may not, -just like any insurance program. They know if they see docs who don't take medicaid they will have to pay; hence this is why they go to clinics. These PFFS plans are created to provide better health care with extra added benefits in real doc's offices (b/c many of these clinics are practiced by residents. ewww).
As a professional agent, you can be held 'liable.' Mary good luck with that case.
If any of you have any questions on duals, let me know. I am very VERY excited to sell Evercare. It's not available in my home state yet but am looking forward to this 'give' away product being where I live, so many are on Medicaid and hoping it will be available for me to represent next year.
