Dual Eligible Madp Question

Seniorgirl411

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Indiana
Is it ever a good idea to put someone on a madp that has medicare and Medicaid? I don't have access to any SNP here in IN. So, it would be a ppo or hmo option. Thanks.
 
Is it ever a good idea to put someone on a madp that has medicare and Medicaid? I don't have access to any SNP here in IN. So, it would be a ppo or hmo option. Thanks.

As long as the provide knows he has full Medicaid then there cannot be any share of cost. Going into an MAPD may increase his access to providers.

However, if he has no issues seeing his doctor and is happy with access, why bother?

Rick
 
Is it ever a good idea to put someone on a madp that has medicare and Medicaid? I don't have access to any SNP here in IN. So, it would be a ppo or hmo option. Thanks.



Because you don't have access to a snp plan you would you want to put a full dual in a non snp plan? not a good idea unless they are partial duals.
 
If a full dual is enrolled in a non snp MA then they may be responsible for cost share.

True, except if the provider is aware that they are dual then they are precluded from balance billing.

Many duals in CA are in traditional MA plans and never experience a share of cost. But unless there is an issue with finding providers in the traditional Medi-Medi system I also shy away from enrolling them into other than a SNP.

Rick
 
Is it ever a good idea to put someone on a madp that has medicare and Medicaid?

In California, the SNP plans offer more benefits than Medi-Medi. They can get free comprehensive dental, eyewear & unlimited transportation which is very important because many are duals due to physical problems that may prevent them from driving.

I have clients that were catching 3 buses to get to their PCP doctor but, under the SNP MA plan, they will be picked up by a van and transported to the doctor's office and back. Transportation also is available to the pharmacy and therapy.

Some of my clients had so few teeth you could count them on one hand. Dental really excited them.

The big drawback is the SNP plan is an HMO while the medi-medi is not limited to a network of doctors. Since almost all duals are on the plan because of physical impairments which prevent them from working, they have specialists. So, finding a SNP plan that includes both their family doctor and specialist is a task.
 
Some states also offer a dual demonstration plan that is basically Medicaid benefits along with an MA contract. These are separate and different from dual SNPs.
 
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