Insurance Agent Forum

[RandyK72]

The question I have for the Indiana Dept of Insurance is "If you are on a medicare advantage plan like Evercare from UNHC instead of the traditional medicare and you have a spend down amount each month, if you have a medical procedure done for which the copay is greater than your spend down, who pays the amount that is over the spend down amount, the person or the state (medicaid) ?" I sent this question to the IDOI last week.

[theinuranceguy]

Originally Posted by RandyK72

The question I have for the Indiana Dept of Insurance is "If you are on a medicare advantage plan like Evercare from UNHC instead of the traditional medicare and you have a spend down amount each month, if you have a medical procedure done for which the copay is greater than your spend down, who pays the amount that is over the spend down amount, the person or the state (medicaid) ?" I sent this question to the IDOI last week.

You pay all copays up to your spend down...

For example if someone had a $200 spend down, when they go to the Dr., instead of paying the traditional 20% for medicare (and that apply to the spend down) they may have a $10 Copay (or no co pay at all)... Either way whatever the Copay is, that is applied to the monthly spend down...

If your Spend Down is $20, and a procedure is $50... You pay the first $20, and medicaid picks up the next $30 and whatver you have done for the rest of the month...

Many times, at least in OH, people dont recieve a Medicaid Card in the mail unless they have met the spend down for that particular month...

Anyone with a spend down is better off with ANY medicare advantage, than just medicare, at least thats my opinion, im sure some people on this forum will disagree...

Others will still argue that a Medicare Sup Makes the most sense... haha