Dual MA Vs Medicaid

[medicareguru]

So the real question is, "what is the purpose of a dual eligible special needs plan?" There is none in my opinion other than the agent trying to get paid a commission.

I mean, maybe there will be some transportation benefits or a gym membership, or some dental if that state's Medicaid program doesn't cover dental, but you are giving that dual eligible a network of doctors.

However, the dual eligible can go in and out of plan as they wish, so I guess it is okay if the agent is looking to have lots of chargebacks.

 

[GreenSky]

So the real question is, "what is the purpose of a dual eligible special needs plan?" There is none in my opinion other than the agent trying to get paid a commission.

I mean, maybe there will be some transportation benefits or a gym membership, or some dental if that state's Medicaid program doesn't cover dental, but you are giving that dual eligible a network of doctors.

However, the dual eligible can go in and out of plan as they wish, so I guess it is okay if the agent is looking to have lots of chargebacks.

You are correct that it's not for the medical benefits but for dental, vision, transportation, etc. I sell the plans on that basis and really don't have a ton of chargebacks.

Also the capitation to the doctors may be better than the FFS from Medicare. And although there is a network, just because a doc can't balance bill (and thanks again for that link), it doesn't mean the dual can find a doc willing to see him/her.

There are reasons these plans make sense.

Rick

 

[Chazm]

So the real question is, "what is the purpose of a dual eligible special needs plan?" There is none in my opinion other than the agent trying to get paid a commission. I mean, maybe there will be some transportation benefits or a gym membership, or some dental if that state's Medicaid program doesn't cover dental, but you are giving that dual eligible a network of doctors. However, the dual eligible can go in and out of plan as they wish, so I guess it is okay if the agent is looking to have lots of chargebacks.

You answer your own question on why someone should choose a dual plan. The better question should be, why wouldn't you choose one?

Medicaid beneficiaries have a network too.

In FL they get silver sneakers, full dental and vision benefits, OTC of up to $50/month, transportation and usually a better network.

 

[midwestbroker]

They may also get an extra layer of care through case management the carrier may offer to members with certain chronic conditions and/or post hospital discharge.

 

[medicareguru]

Medicare is primary and Medicaid is secondary. For a Medicare beneficiary that has full QMB status, the doctors are not allowed to bill for any deductibles or coinsurance. That is the point when I ask the real point for a Medicare beneficiary to be enrolling in a Special Needs Plan. With original Medicare and Medicaid (full QMB), there is no network. Any Medicare provider regardless of whether the provider is Medicaid certified or not will provide excellent coverage.

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Chazm- A better network then original Medicare?

 

[steveadlman]

The answer to all the questions is yes - at least in most instances.

Rick

Do doctors receive more from the MAPD Plan than they would if the person just had Medicare and Medicaid?

 

[yogooglethis]

New to the Dual Plans! In a nutshell, couple of inquiries:
1. Why would a Dual plan serve a person better than Medicare/Medicaid?
2. Do doctors prefer reimbursement from Dual Plan over Medicaid?
3. When on a Dual Plan or any MA/MAPD plan, can the person go back to Medicaid whenever they wish?
In advance, thank you for your feedback. I greatly appreciate it!

Kindest Regards.....and have a great Holiday Season.

Why? So the member can have an agents name on their cellaphone speed dial when they need the MA plans customer service phone number because they can't find their ID card again. HaHa. I am only half kidding. I think some of these people , especially the ones new to the dual Medicaid system and without long time established providers , need the road map that these plans offer i.e provider directories, an 800# to call other than Medicaid that they can actually reach someone on, local agent, care management etc.

I believe reimbursements are about the same however I think providers prefer to deal with Medicare because they can get away with much more creative coding-especially the DME providers, podiatrist, chiropractic's and home health agencies

 

[Chazm]

Medicare is primary and Medicaid is secondary. For a Medicare beneficiary that has full QMB status, the doctors are not allowed to bill for any deductibles or coinsurance. That is the point when I ask the real point for a Medicare beneficiary to be enrolling in a Special Needs Plan. With original Medicare and Medicaid (full QMB), there is no network. Any Medicare provider regardless of whether the provider is Medicaid certified or not will provide excellent coverage. ---------- Chazm- A better network then original Medicare?

If you are telling Dual individuals that they can go to any doctor that accepts Medicare, you are going to have some pissed off clients when they get told to go to a Medicaid approved doctor

 

[medicareguru]

Chazm-

Are you saying that a Medicare provider can bill a Medicare beneficiary for the 20% if that MB is full QMB status?

 

[GAJ638]

Medicare is primary and Medicaid is secondary. For a Medicare beneficiary that has full QMB status, the doctors are not allowed to bill for any deductibles or coinsurance. That is the point when I ask the real point for a Medicare beneficiary to be enrolling in a Special Needs Plan. With original Medicare and Medicaid (full QMB), there is no network. Any Medicare provider regardless of whether the provider is Medicaid certified or not will provide excellent coverage.

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Chazm- A better network then original Medicare?

Ok here is a question. A few years ago I ran into a DE person. His primary doctor accepted Medicare/medicaid. His specialist accepted Medicare but did not accept medicaid. He was be being billed for what medicaid would normally pay. I checked the provider directory and his Specialist was listed. Wrote him a Duel complete and now he pays no copays to the specialist.(so he says) Question do you not run into cases where some doctors will not accept Medicaid but will be in network on an DC plan?