Insurance Agent Forum

What is your understanding of Dual Eligibles (eligible for full Medicare and full Medicaid)?

Let's say a DUAL takes out a MA plan with $0 premium with the following copays:

--$15 doctor visit
--$50 ER visit
--$150/day days 1-5 inpatient
--$100 outpatient surgery
--$25 Urgent care center

Does Medicaid pay these copays...regardless of whether the MA plan is considered a SNP (Special Needs Plan)?

[maryjd123]

Kyle

according to the medicaid office in my state --- everything is still paid for by Medicaid -- but that is also state regulated -- they did say in different states that the patient is responsible for the copays -- that is something you will have to call medicaid about on Monday morning - so you can get the green light

Mary

[midwestbroker]

The way the system is designed, Medicaid would pay the co-pay and then the insurance carrier would pay the rest.

But, in some states that is not how it works. In Missouri, Medicaid wants nothing to do with MA plans, so when you hit your spend down, you still have to pay your co-pays.

Check with your state Medicaid.