Why Should Medicare Medicaid Dual Eligibles Join a MAPD?

[midwestbroker]

Disease management could also be a reason to join a MAPD plan. Some carriers offer a case worker to help their members for certain conditions, post hospitalization, etc.

 

[yogooglethis]

Disease management could also be a reason to join a MAPD plan. Some carriers offer a case worker to help their members for certain conditions, post hospitalization, etc.

What he said and a defined network offers a road map to follow which many times this population needs.

And lets not forget the benefit of having a local agent to call when they can't find their doctors phone number etc. ha ha

 

[NCDualSNPGRL]

Dual plans are great for these members. Depending on the area, they have access to HMO/PPO plans, most of members Medicaid or QMB plans pay most of IF not ALL of their copys, co-insurance and deductibles and in some states, they pay out of network costs as well as the premiums. It gives extra benefits like gym memberships, transportation, vision, hearing (covers hearing aids) dental (some plans cover dentures/implants), medical alert buttons at no cost, and now some dual plans are offering virtual visits with no copay. Some companies now have "onboarding" for these members and the departments help these members find doctors in network and set them up with their OTC benefits etc.

 

[SoCalFMO]

Dual plans are great for these members. Depending on the area, they have access to HMO/PPO plans, most of members Medicaid or QMB plans pay most of IF not ALL of their copys, co-insurance and deductibles and in some states, they pay out of network costs as well as the premiums. It gives extra benefits like gym memberships, transportation, vision, hearing (covers hearing aids) dental (some plans cover dentures/implants), medical alert buttons at no cost, and now some dual plans are offering virtual visits with no copay. Some companies now have "onboarding" for these members and the departments help these members find doctors in network and set them up with their OTC benefits etc.

Exactly right. Well said ma'am.

 

[GreenSky]

Dual plans are great for these members. Depending on the area, they have access to HMO/PPO plans, most of members Medicaid or QMB plans pay most of IF not ALL of their copys, co-insurance and deductibles and in some states, they pay out of network costs as well as the premiums. It gives extra benefits like gym memberships, transportation, vision, hearing (covers hearing aids) dental (some plans cover dentures/implants), medical alert buttons at no cost, and now some dual plans are offering virtual visits with no copay. Some companies now have "onboarding" for these members and the departments help these members find doctors in network and set them up with their OTC benefits etc.

Providers are not allowed to balance bill duals (at least in CA) regardless of their providers' status with Medicaid. So a zero copay, etc. is meaningless.

The only advantage MIGHT be a better network and some perks like dental and vision.

Rick

 

[axeman462]

I am in AZ and I have met a couple people lately that were on AHCCCS (AZ's Medicaid program) before they become eligible for Medicare. They have become so comfortable with Medicaid that they are hesitant to consider MAPDs for dual eligibles. Other than benefits such as dental, vision and OTC stuff that are offered by MAPDs for the duals, are there any other reason why these people should consider signing up for a dual program?

TIA.

Because you make a commission

 

[MedicareMillionair]

Yeah, it's hard to make a living when only 85-90% remain on the books from year to year.

At least that's my experience. Those that have your attitude probably don't sell duals.

Rick

I'm in agreement with you. I have very high customer satisfaction and retention rate from Duals. I also believe it's a misconception that they are high maintenance as many state,. They pay for nothing, this eliminates much service work. In SC, many doctor's charge a small fee for a visit, I instruct my clients to state this is not acceptable as they have a MA plan therefore have "No" fee.

Sometimes we trivialize the freebies, but they can make a difference. Almost every one of my clients take vitamins; with OTC benefits, they get them free often. They get dentures from many plans. They have membership to the local YMCA, whether they use it or not. These things make a difference. Remember, the reason these people are on medicaid is mostly because they have a very low fixed income. Why would an agent not try and help them..

Yes they can. I don't mess with some of those people because Medicaid can better serve them sometimes. Like with home healthcare.

But if the are really unorganized, or have no one to help them, then I think a dual plan can help them.

My clients on dual plans seem to do fine with home healthcare. Although I have no statistical data to back that up. Also, most plans now have upticked their case management and are conducting monthly "is everything ok?" calls. They are always trying to help out and insure benefits are being taken advantage of. Not really acting like the evil insurance companies they are made out to be.

I do agree for some very independent, often stubborn people, it's best to pass on selling them dual plan. But even in that case, why would they not want to increase their benefits? It's not logical.

 

[Packerland]

Yeah, it's hard to make a living when only 85-90% remain on the books from year to year.

At least that's my experience. Those that have your attitude probably don't sell duals.

Rick

From a recent UHC study the average person on an MAPD stays 4.2 years and the average person on a MAPD DUAL stays on for 4.7 years..

I used to have that same mindset as you and I start tracking my clients and actually do have really good staying power with those

 

[Desmond Doss]

Should the question be "why would a Dual NOT get a dual plan?"

In addition to Medicare and Medicaid in MO:

$0 co pay eye exam once/year
$200 glasses/frames/contacts every year
$1500 Preventive Dental every year
$0 co pay Personal Emergency Response system
$0 co pay Hearing exam every year
$2000 Hearing aid benefit every 2 years
$0 copay Transportation for 18 RT to Health Providers
$700 a year in $0 copay OTC Health goods

 

[Chazm]

ppo dual benefits here in FL.
Also, for any share of cost clients I can put them on a partial Medicaid plan with all zero cost share down the board