Med 4 Home Question

jmarkk1

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I met with a client that is on A and B only. He has COPD/emphysema and receives oxygen, breathing machine, and pulmicort from Med 4 Home totally for free.

He was told that if he was to get supplemental insurance, his benefits with Med 4 Home would go away.

The only thing that can be done is a MA plan, but is it worth it to have him apply only to have Med 4 Home drop him? or are there any other options?
 
I guess they have him on some sort of low income assistance program they have.

I personally try to get all my clients to avoid those mail order systems like Liberty or Med4Home... they cost Medicare way too much for the exact service the local pharmacy or supplier can give them.

Some MA plans have perferred providers for those services and his out of pocket cost could be very low or even $0.
 
I guess they have him on some sort of low income assistance program they have.

I personally try to get all my clients to avoid those mail order systems like Liberty or Med4Home... they cost Medicare way too much for the exact service the local pharmacy or supplier can give them.

Some MA plans have perferred providers for those services and his out of pocket cost could be very low or even $0.

Is there a way to check with the MA plan about payment first?
If he is eligible for LIS?
 
Medicare.gov for checking LIS. You'll need his medicare number, zip, date of birth, etc.

Checking for payment, read the summary of benefits or consult the plan you have in mind.
 
I met with a client that is on A and B only. He has COPD/emphysema and receives oxygen, breathing machine, and pulmicort from Med 4 Home totally for free.

He was told that if he was to get supplemental insurance, his benefits with Med 4 Home would go away.

The only thing that can be done is a MA plan, but is it worth it to have him apply only to have Med 4 Home drop him? or are there any other options?

The part about Med4Home going away if he gets a Supp doesn't sound right. But that may be closer to a true statement if he gets an MA plan. The ballgame would change at that point, almost certainly... as it then depends on what the contract states for benefits.

Many times, when someone is really sick and having lots of doctoring, an MA plan may not be the answer even compared to Med A&B only with no supp. Case in point, patient goes to see specialist with Orig Med A&B, bill is 200 bucks, Med approves 80, and pays 64, and the patient is respons for 16... billed after services and med pays... compared to maybe 25 bucks due at the time of the service, if a MA co-pay.

LIS is going to deal with the cost of his Rx, and nothing else. The income limit to qualify is not more than 150% of Fed Poverty Level FPL, which now stands at 1362 per mo for a single person, and 1839 mo for married persons. Also an asset test where they cannot have more than 12,640 for single and 25,280 for married, in liquid assets (Cash or cash equiv), outside the value of a home, car, and other fixed and non-liquid assets.

Doesn't the inhaler and supplies for such fall under Part B expenses...? If so, LIS won't help with that one bit; only Rx that is billed under Part D. Does he have a Part D plan...? If he does you would see that under the Med.gov site if you go in with the info from his Med card, will need to know what month and yr that he qualified for Part A Med in addition to the dob, zip code, Med #, etc, as stated, along with what % of Extra help that he is receiving.

Sounds like to me he is a candidate to stay on Orig Med and qualify for Extra Help as best he can... and a Part D plan at 12.00 per month prem, or in some cases there is no prem if extremely low income. Also no Part D late enrollment penalty if he qualifies for LIS either. This way his Rx could be as low as 1.10 and 3.30 if full subsidy, or increasing amounts if partial subsidy. He can enroll for LIS on the Soc Sec site, takes about 10 mins to enroll them online, and then about 30 days for determination. Most folks on Medicaid are already receiving LIS though.
 
The part about Med4Home going away if he gets a Supp doesn't sound right. But that may be closer to a true statement if he gets an MA plan. The ballgame would change at that point, almost certainly... as it then depends on what the contract states for benefits.

Many times, when someone is really sick and having lots of doctoring, an MA plan may not be the answer even compared to Med A&B only with no supp. Case in point, patient goes to see specialist with Orig Med A&B, bill is 200 bucks, Med approves 80, and pays 64, and the patient is respons for 16... billed after services and med pays... compared to maybe 25 bucks due at the time of the service, if a MA co-pay.

LIS is going to deal with the cost of his Rx, and nothing else. The income limit to qualify is not more than 150% of Fed Poverty Level FPL, which now stands at 1362 per mo for a single person, and 1839 mo for married persons. Also an asset test where they cannot have more than 12,640 for single and 25,280 for married, in liquid assets (Cash or cash equiv), outside the value of a home, car, and other fixed and non-liquid assets.

Doesn't the inhaler and supplies for such fall under Part B expenses...? If so, LIS won't help with that one bit; only Rx that is billed under Part D. Does he have a Part D plan...? If he does you would see that under the Med.gov site if you go in with the info from his Med card, will need to know what month and yr that he qualified for Part A Med in addition to the dob, zip code, Med #, etc, as stated, along with what % of Extra help that he is receiving.

Sounds like to me he is a candidate to stay on Orig Med and qualify for Extra Help as best he can... and a Part D plan at 12.00 per month prem, or in some cases there is no prem if extremely low income. Also no Part D late enrollment penalty if he qualifies for LIS either. This way his Rx could be as low as 1.10 and 3.30 if full subsidy, or increasing amounts if partial subsidy. He can enroll for LIS on the Soc Sec site, takes about 10 mins to enroll them online, and then about 30 days for determination. Most folks on Medicaid are already receiving LIS though.

What about going through a SNP? He isn't on Medicaid, but according to Med4Home, he qualifies for hardship program. He does have concerns about medical expenses with A and B. I've seen a few SNP plans in his area that seem to pay 100% of all costs, but I'm not contracted to offer them. Molina is the only SNP in his area.
 
What about going through a SNP? He isn't on Medicaid, but according to Med4Home, he qualifies for hardship program. He does have concerns about medical expenses with A and B. I've seen a few SNP plans in his area that seem to pay 100% of all costs, but I'm not contracted to offer them. Molina is the only SNP in his area.

Here is the Guide to SNP. Read it get completely conversant with it so you know the turf.

SNP's are synonymous with Medicaid and Medicare together, meaning dual eligible folks, although a few other special circumstances can trigger the SNP too. Doesn't sound like your guy is on Medicaid, which is super low income... I'm surprised at the folks that live on < 700 mo and do not qual for M'caid. So get the complete facts from him, know your local county perameters for M'caid qual, and go forth young man.
 
Here is the Guide to SNP. Read it get completely conversant with it so you know the turf.

SNP's are synonymous with Medicaid and Medicare together, meaning dual eligible folks, although a few other special circumstances can trigger the SNP too. Doesn't sound like your guy is on Medicaid, which is super low income... I'm surprised at the folks that live on < 700 mo and do not qual for M'caid. So get the complete facts from him, know your local county perameters for M'caid qual, and go forth young man.

I just posted another comment in my thread on dual eligibles.
Thx for this guide. Can you comment at all on the "holes" in coverage that exist with someone that is on Medicaid and Medicare? in other words...how can a MA plan help if they have all their expenses paid for etc.?
 
I just posted another comment in my thread on dual eligibles.
Thx for this guide. Can you comment at all on the "holes" in coverage that exist with someone that is on Medicaid and Medicare? in other words...how can a MA plan help if they have all their expenses paid for etc.?

If you refer to the other post you'll see your question answered (I think pretty thoroughly). The document referenced above isn't going to do a great job explaining how Medicare and Medicaid work together because it varies by state and sometimes even county. It's sort of a cluster because they don't talk to each other vs Medicare plans which all more or less behave the same way across the country.

MA plans usually are only attractive to duals if:
-They want to see a doctor that doesn't accept Medicaid, but is in the plan they are going to use
-They can get extras like glasses, dental, etc.
 
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