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

[yorkriver1]

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.

Sounds like a good call.

So, if she reapplies for MSP, she might get QI, (again?) which Medicare.gov info says has to be reapplied for each year (but not QMB or SLMB). It also says you can't have that and Medicaid.

I am new enough that I haven't had anyone be dropped from MSP yet--still helping them apply for LIS/MSP, about 18 months of that. So far only issue is how long it takes Medicare to refund any B premiums they paid while waiting for app to be approved.
Link to info on Medicare Savings Programs:
https://www.medicare.gov/your-medic.../medicare-savings-programs.html#collapse-2624

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[TN_agent]

This seems like a good thread to ask this question.

The Medicare website says that they forward the information on extra help applications to the state MSP. I just had a lady (who was already getting extra help) apply for more extra help. She was NOT eligible for Medicaid, so it said she could fill out another app. She should be SLMB. But she received a letter stating that they did not have any adjustments and were not taking any action on the new application. I don't get that, because her husband died and she had been getting partial extra help and by my calculations should now be full extra help on RX AND SLMB without his social security coming in. Can I be sure that they forwarded that application to the state? I assumed that the "no action taken" referred only to not changing her federal subsidy, but that they would still send the app to the MSP. She has not heard anything back and it has been over 6 weeks.

She is really tight right now and needs that $104.90 a month. I am wondering if we need to apply with the state directly for her? Or appeal? I don't understand why they didn't change her level of help since her income is lower.

 

[yogooglethis]

This seems like a good thread to ask this question.

The Medicare website says that they forward the information on extra help applications to the state MSP. I just had a lady (who was already getting extra help) apply for more extra help. She was NOT eligible for Medicaid, so it said she could fill out another app. She should be SLMB. But she received a letter stating that they did not have any adjustments and were not taking any action on the new application. I don't get that, because her husband died and she had been getting partial extra help and by my calculations should now be full extra help on RX AND SLMB without his social security coming in. Can I be sure that they forwarded that application to the state? I assumed that the "no action taken" referred only to not changing her federal subsidy, but that they would still send the app to the MSP. She has not heard anything back and it has been over 6 weeks.

She is really tight right now and needs that $104.90 a month. I am wondering if we need to apply with the state directly for her? Or appeal? I don't understand why they didn't change her level of help since her income is lower.

Yes you can send in application to state without negatively effecting anything however based on what you said I would be curious as to what her stated assets were on the LIS application because this information is transferred from SS to the state medicaid and as you know allowable asset for LIS is higher then state Medicaid allowable assets.Also i have found that people sometimes give wrong information about assets when applying for LIS. ie they will give DB amount of life insurance instead of cash value

 

[TN_agent]

Her assets are basically nothing after spending savings on medical bills (less than $1000 according to what she told me). She has some sort of non-cash-FE or Life policy that she pays for monthly, no retirement savings, etc. She gets like $1050 in SSI each month to live on, food stamps, etc. They should know that her husband died. She is drawing off of his work record. On Medicare.gov, she was listed as partial extra help (100%) since 2010. He has died since then, a little over a year ago.

She is pretty destitute. Her kids have been helping her out with paying for RX, electricity, etc.

I am pretty new to Medicare sales myself, there is still a lot I don't know. Not sure how to handle this one. Should I have her call to see if the state Medicaid even got the application from SSA?

 

[yorkriver1]

Your state may have a toll free # to call. In ours, you can call and enter the SS# to get app update. Live personnel can also do a search, but that would be a 3 way call. If you search for Medicaid with your state name, it may come up. I am going to help a relative of one of my clients today. Widower, cared for spouse with degenerative nervous system illness for 30 years, now resorces depleted, living alone, early 80's, never had medsupp or drug plan. We will see about LIS app, follow up with MSP app that is automatically filed.
I need to see about LIS first, may qualify for MAPD/PDP SEP, not afford medsupp.