I took a dual off a supplement two years ago and put her on Wellcare, which is and was the only SNP in that county. Now that Wellcare has pulled out for 2010 should I do anything with her?
I never thought her med sup did anything for her and I thought her Wellcare gave her a few little extras per month, but should I just do nothing now? Of course she has her stand alone PDP.
You should of left her on the med supp in the first place so she wouldnt have had to keep messing with it! Im not exactly following you here but yea you owe it to her to do something being you are the one that got her into this mess.
How does a dual afford a supplement and why would they waste the money if they could? The state medicaid is covering the 20% medicare doesnt whether they have a supplement or not. If there are no other dual MA plans that give them a couple add-on benefits then i would just leave them alone with their medicare/medicaid/pdp.
Dow, I'm thinking that you might be confusing some terminology. Not being critical, but the scenario you presented in this thread is hard to fathom. I can't think of an instance in which a dual should be on ANY supplement-- much the less, part D. Further, I'd be concerned that such a situation might jeopardize the dual's continued eligibility for Medicaid. On the other hand, a person that qualifies for a SNP simply by virtue of medical condition would certainly be a good candidate for a supplement-- provided they can get underwritten...
I took a dual off a supplement two years ago and put her on Wellcare, which is and was the only SNP in that county. Now that Wellcare has pulled out for 2010 should I do anything with her?
I never thought her med sup did anything for her and I thought her Wellcare gave her a few little extras per month, but should I just do nothing now? Of course she has her stand alone PDP.
If the person is a QMB plus, {full medicaid}, they should have not been on a med sup sup to start with. Wellcare is not an SNP. {Well, maybe it is where you are?}
If the person is a QMB/LIS/QU1 dual, an MA/MAPD plan may be of benefit.
With Wellcare ending, you can move her to a med sup on a GI basis. I just did one today for an LIS dual. She was on Wellcare's Sonata PFFS. She gets her part B premium paid and her part D. She is not a QMB Plus and needs something to pay the Medicare deductables and co-insurance. I really don't think that she can afford the med sup, but, she insists that she is done with MA plans and wants a med sup. If I didn't sell her one, she was going to somebody that would.
You need to find out what level of dual this person has. If she is truly a medicaid enrollee, there is nothing for her that she needs. If there is a true SNP available, that might be of benefit to her.
I've ran into some duals that have a spend down of $300-400/mo so they carry a supplement to protect that spend down dollar. It covers first dollar expenses. I may be wrong in understanding their situation and have asked them if they asked their case worker at medicaid and they said that they were told they could/should keep it.
It didn't make sense to me so I kept my distance. Why spend $110-140/mo 100% of the time to protect $300-400/mo on the occasions your medical bills reach that level.
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Originally Posted by Yoda
That being said for the most part I think Michael Moore is dead on. .
I've ran into some duals that have a spend down of $300-400/mo so they carry a supplement to protect that spend down dollar. It covers first dollar expenses. I may be wrong in understanding their situation and have asked them if they asked their case worker at medicaid and they said that they were told they could/should keep it.
It didn't make sense to me so I kept my distance. Why spend $110-140/mo 100% of the time to protect $300-400/mo on the occasions your medical bills reach that level.
I've run into those as well. They can legally keep a med sup for those spend down dollars. An MA makes much more sense for those folks, but, to each his own.
I thought that Wellcare was an MAPD-- but you say she has stand alone part D? What supplement could she have had since she was a dual?
I believe as late as 2008 Wellcare sold a plan just for duals called the Duet. It was an MA. She had an assigned PDP, from CCRx. I did not rewrite that.
I was pretty PO'd that there was no gatekeeper in place to keep her from throwing away money on a sup.
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Originally Posted by HealthResourceAdvisor
How does a dual afford a supplement and why would they waste the money if they could? The state medicaid is covering the 20% medicare doesnt whether they have a supplement or not. If there are no other dual MA plans that give them a couple add-on benefits then i would just leave them alone with their medicare/medicaid/pdp.
This is exactly what I thought. She didn't have much money left over at the end of the month after she paid for the sup. I didn't think she really even needed the MA except for a few extra benefits she wouldn't get through Medicaid.
The way I met her is at 85, she became the live in girlfriend of a 79 year old client of mine. Otherwise I probably would not have given her the MA.
I'm thinking just leave it alone, but i'm going to talk to her case worker first. I don't know about other states, but here in Iowa it's hard as hell to reach anyone with the state to talk to. When you do they cannot answer the question.
Last edited by Dowejonez : 11-06-2009 at 12:13 AM.
Reason: Posts merged
In most states, I know TN and GA....... never put a dual on MedSup!
as was said before, state pays all co-pays and/or deductable. All the apps I write ask if they have medicaid. i didnt think they would even issue. I know even old indemnity products Cancer ect. will return permiums for all the past premiums because they could not produce a statement .
In most states, I know TN and GA....... never put a dual on MedSup!
as was said before, state pays all co-pays and/or deductable. All the apps I write ask if they have medicaid. i didnt think they would even issue. I know even old indemnity products Cancer ect. will return permiums for all the past premiums because they could not produce a statement .
All duals are not the same. A QI-1 is a dual, but they do not get the medicare deductables and coinsurance paid. Same for an LIS dual.
You would never put a full medicaid dual on a med sup, but, one cannot make a blanket statement to not put any duals on med sups or MA.
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Originally Posted by Dowejonez
I believe as late as 2008 Wellcare sold a plan just for duals called the Duet. It was an MA. She had an assigned PDP, from CCRx. I did not rewrite that.
I was pretty PO'd that there was no gatekeeper in place to keep her from throwing away money on a sup.
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This is exactly what I thought. She didn't have much money left over at the end of the month after she paid for the sup. I didn't think she really even needed the MA except for a few extra benefits she wouldn't get through Medicaid.
The way I met her is at 85, she became the live in girlfriend of a 79 year old client of mine. Otherwise I probably would not have given her the MA.
I'm thinking just leave it alone, but i'm going to talk to her case worker first. I don't know about other states, but here in Iowa it's hard as hell to reach anyone with the state to talk to. When you do they cannot answer the question.
Wellcare's Duet was not ever an sNP. It was still around for 2009 with a name change to Melody, but, it was still not a SNP. It was marketed to full dual medicaid primarily and it gave benefits like dental, eyeglasses, hearing aids and over the counter stuff to those enrollees. If she was on Duet, she was most likely medicaid. She did not need a med sup and probably had it before being on medicaid. They are allowed to keep their med sup if they are already on it. Why one would do that is questionable.
If she is still on full medicaid, {QMB Plus}, you can't put her on a med sup now even with Wellcare ending. She doesn't need one anyway. The only thing that might possibly help her is a true SNP if there is one available.
Last edited by jdeasy : 11-06-2009 at 08:47 AM.
Reason: Posts merged
DOWEJONEZ SAID- "The way I met her is at 85, she became the live in girlfriend of a 79 year old client of mine. Otherwise I probably would not have given her the MA."
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OH FOR GODS SAKES ENOUGH WITH THIS STORY ALREADY!
DOWEJONEZ SAID- "The way I met her is at 85, she became the live in girlfriend of a 79 year old client of mine. Otherwise I probably would not have given her the MA."
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OH FOR GODS SAKES ENOUGH WITH THIS STORY ALREADY!
If we take up a collection, will you go away. I'm thinking we can double your annual income with $125.
Rick
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Training, Community, Support, and Success Independent Life Insurance Agents Assn rick@iliaa.org
DOWEJONEZ SAID- "The way I met her is at 85, she became the live in girlfriend of a 79 year old client of mine. Otherwise I probably would not have given her the MA."
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OH FOR GODS SAKES ENOUGH WITH THIS STORY ALREADY!
Well....that's my story and I'm sticking with it. I spent parts of several days trying to make sure she was a true dual but never could absolutely confirm it. I wrote the MA to make sure she had her bases covered.
I figure she had the sup before she went on Medicaid. She had been paying AARP for 10 years and had been on Medicaid for most of that time.
Yes...I had read on here that Wellcares Duet was not as suitable as Wellcare claimed. That was the only piece of business I ever wrote with them, but I'd already placed it so left it alone.
Yoda...you do not know anything about how I work, so keep your generalizations to yourself. I give up a ton of commission every year for the sake of my clients. After 22 years in the business I always help my clients make a decision in their best interest. Period.
GORDON SAID- "All Yoda offers is generalizations. I don't think he has any real market knowledge. None.
After all. He's worships at the alter of MM"
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I will tell you kids one religion I do subscribe too and that is "I pick my clients they don't pick me".......Just because someone has a pulse and I can sell them something does not mean I should........If you come across a broke 85 year old lady who is moving in with her 75 yr old boyfriend who is possibly on medicaid you are supposed to get the hell out of there fast you dumbasses! How many signs on the wall saying "run fast" do you need to get the picture?
Well....that's my story and I'm sticking with it. I spent parts of several days trying to make sure she was a true dual but never could absolutely confirm it. I wrote the MA to make sure she had her bases covered.
I figure she had the sup before she went on Medicaid. She had been paying AARP for 10 years and had been on Medicaid for most of that time.
Yes...I had read on here that Wellcares Duet was not as suitable as Wellcare claimed. That was the only piece of business I ever wrote with them, but I'd already placed it so left it alone.
Yoda...you do not know anything about how I work, so keep your generalizations to yourself. I give up a ton of commission every year for the sake of my clients. After 22 years in the business I always help my clients make a decision in their best interest. Period.
You might consider referring these low income prospects to the state SHIP. The toll-free number is on the back of their "Medicare & You book". I find this a good practice.
I don't think it is ethical to sell a MA plan to a dual eligible UNLESS THAT MA PLAN IS COORDINATED WITH MEDICAID.
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