Would a SNP Dual Plan Honor $0 Copays when Mb Has Lost Medicaid?

[wehotex]

Every once in a while, a mb is enrolled in a Dual plan (Full Dual), but has lost medicaid due to ineligibility. I just had one mb who is due to start CIP Dual even though she is NOT a full Dual (QI-1). If the person were to be hospitalized for example, would the providers need to see proof of Medicaid for the copays to be waived or would they just honor the stated benefits?

 

[GreenSky]

Every once in a while, a mb is enrolled in a Dual plan (Full Dual), but has lost medicaid due to ineligibility. I just had one mb who is due to start CIP Dual even though she is NOT a full Dual (QI-1). If the person were to be hospitalized for example, would the providers need to see proof of Medicaid for the copays to be waived or would they just honor the stated benefits?

If you look at the SOB you should get the answer. Generally they show two different benefits. One for full dual and one for others.

Rick

 

[policy doctor]

Well if Medicaid pays the 20% left after Medicare, and client loses their Medicaid benefits, then technically they(client) owe the balance. But if they're broke and have no assets....I guess it's written off as uncollectable.

 

[MedicareAgent]

If a customer loses their status they will then pay a % of all the bills and doctors will refuse to see them because a copay is now required at time of visit. The client should be switched to a diff. plan at that point.

 

[axeman462]

if the benny lost medicaid, then they would also lose the SNP plan, and they would automatically be put on original Medicare

 

[MedicareAgent]

if the benny lost medicaid, then they would also lose the SNP plan, and they would automatically be put on original Medicare

No actually they are not automatically put back to original medicare.
The customer can stay on the snp (although I do not know why they would) for 6 months, if within the 6 month period they do not get their Medicaid status back they are then dis enrolled by the company and put back to original Medicare.

 

[wehotex]

if the benny lost medicaid, then they would also lose the SNP plan, and they would automatically be put on original Medicare

Yes, but that takes time. It could take months for the MA plan to notify the mb that it knows that the mb doesn't have any Medicaid.

 

[GreenSky]

No actually they are not automatically put back to original medicare.
The customer can stay on the snp (although I do not know why they would) for 6 months, if within the 6 month period they do not get their Medicaid status back they are then dis enrolled by the company and put back to original Medicare.

I hope you are making a plan/state specific comment rather than "this is the way it always works."

Rick

 

[MedicareAgent]

https://www.medicare.gov/Pubs/pdf/11302.pdf

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I hope you are making a plan/state specific comment rather than "this is the way it always works."

Rick

I'm simply stating from experience.

 

[GreenSky]

I'm simply stating from experience.

Your experience might be different in other areas.

Rick