Medicaid Spendown Costing More Than a Plan F! Any GI or SEP?

[vic120]

Dont assume just because she is 86 she won't pass automatically, I have had a few just over 80 pass no problem. The commission is lowered but if they can pass and can afford it why shouldn't they have it

What kind of health issues does she have?

Check underwriting many things can pass through equitable, new era, sometimes Aetna as last resort check AARP

I believe the premiums count towards spend down as well

 

[MedicareMegan]

Thanks for the great advice! She has spinal stenosis

 

[Chazm]

You need to see if there are dual MAPD plans in your area. If she's on Medicaid, chances are she can't afford a Supp.
In my area, I would put someone with share of cost on a $0 premium plan, $0 doctor, $0 specialist, $0 inpatient and out patient hospital. Etc.

 

[vic120]

Thanks for the great advice! She has spinal stenosis

You'd have to check the underwriting questions, I think maybe Phil amer, I have not run into that much

But the very worse case scenario she would qualify for AARP at the very least level 2 premium which should be less then send down


2nd this is MO right?

if so there is the anniversary rule, even if you get high premium the month of anniversary for the policy she can switch to company with lower premium GI

 

[Ronnie Carter]

You need to see if there are dual MAPD plans in your area. If she's on Medicaid, chances are she can't afford a Supp.
In my area, I would put someone with share of cost on a $0 premium plan, $0 doctor, $0 specialist, $0 inpatient and out patient hospital. Etc.

Problem is, lots of DSNP's require QMB or FBDE and won't cover someone who's only SLMB. But what bothers me is that Medicaid isn't paying her Part B any more, which means she's not even SLMB. I did not know there was any level of Medicaid that didn't at least pay Part B premiums.

Depends on the carrier, but I rather doubt she'd qualify for a DSNP unless I'm missing something here. And Medicaid benefits do vary from state to state.

 

[vic120]

You need to see if there are dual MAPD plans in your area. If she's on Medicaid, chances are she can't afford a Supp.
In my area, I would put someone with share of cost on a $0 premium plan, $0 doctor, $0 specialist, $0 inpatient and out patient hospital. Etc.

I really avoid the duels so I don't know and am curious does that work the same when there is a spend down involved $0 copay's or do they have to pay cost share till the meet spend down?

 

[GreenSky]

I really avoid the duels so I don't know and am curious does that work the same when there is a spend down involved $0 copay's or do they have to pay cost share till the meet spend down?

I agree. Duels can be very dangerous and in fact Somarco told me about how he watched Arron Burr shoot Alexander Hamilton in a duel.

Duals on the other hand can be a terrific market.

Rick

 

[vic120]

I agree. Duels can be very dangerous and in fact Somarco told me about how he watched Arron Burr shoot Alexander Hamilton in a duel.

Duals on the other hand can be a terrific market.

Rick

I am sure it is and I am not knocking it. Just saying for me it is not my market and find no need to get involved too much, Although I run into one here and there usually refer out, and I was just curious as well to the answer to the question

 

[Chazm]

I really avoid the duels so I don't know and am curious does that work the same when there is a spend down involved $0 copay's or do they have to pay cost share till the meet spend down?

I've up my filter to exclude poorer areas because I'm tired of dealing with so many Medcaid clients but if they have share of cost or spend down, what ever you call it, they pay what the plan says. They don't have to meet the share of cost.

I've had clients with QI1 pay zero for everything.

 

[yogooglethis]

You need to see if there are dual MAPD plans in your area. If she's on Medicaid, chances are she can't afford a Supp.
In my area, I would put someone with share of cost on a $0 premium plan, $0 doctor, $0 specialist, $0 inpatient and out patient hospital. Etc.

In Fl. I know that Wellcare ,Coventry and I am sure some others have MA SNP Plans that zero out all copayments even for the partial duals and I agree it's seems strange to be chasing a med supp lead who 's income is so low that they recently had a Medicare Savings Program.


I think the OP should try first to help the client fill out the paperwork to recertify for her Medicare Savings Program.That may not lead directly to a sale but it will probably resolve everything for the client.