If a person is QI, do they have to get a regular MAPD?

[jack3454]

Im running into a lot of QI on the medicare savings program, however I can't find a single carrier that allows a QI into their DSNP plans, they always have to be enrolled in a standard MAPD plan. Is this typically the case?

Also, if a QI is on a regular MAPD, the only benefit with this is them getting extra help, right? How do you estimate drug costs with a QI?

 

[Special Agent]

Im running into a lot of QI on the medicare savings program, however I can't find a single carrier that allows a QI into their DSNP plans, they always have to be enrolled in a standard MAPD plan. Is this typically the case?

Also, if a QI is on a regular MAPD, the only benefit with this is them getting extra help, right? How do you estimate drug costs with a QI?

Most DSNP allow q1 members to enroll the question is how do they help with cost share.Some plans are friendlier to partials than others.In Florida for example UHC the members with partial have no cost share protection while Aetna ,Humana,Welllcare have plans that pay down that cost share.Go to UHC jarvis and do a medicare search and it will tell you what LIS level they are at.

A person that qualifies for Q1 on a MAPD will qualify for a medically needy status which pays the entire cost share for the month if they meet their share of cost for the month at medicaid approved providers.Hospitals will usually submit these bill to medicaid but OP cost usually have to be submitted by member to medicaid.

 

[DonP]

Most DSNP allow q1 members to enroll the question is how do they help with cost share.Some plans are friendlier to partials than others.In Florida for example UHC the members with partial have no cost share protection while Aetna ,Humana,Welllcare have plans that pay down that cost share.Go to UHC jarvis and do a medicare search and it will tell you what LIS level they are at.

A person that qualifies for Q1 on a MAPD will qualify for a medically needy status which pays the entire cost share for the month if they meet their share of cost for the month at medicaid approved providers.Hospitals will usually submit these bill to medicaid but OP cost usually have to be submitted by member to medicaid.

That's very very rare . I work 5 states and none of those states have any cost share for partial Medicaid ( Qi1 , slmb and qdwi) . The only advantage of partial Medicaid is a partial plan with better benefits and sometimes a lower copay at Dr . Also they get there part b premium paid and most partial plans have 0 copays on all rx's . The good and bad of working the dsnp mkt . The good is the new part d law doesn't affect them so no need to check rx's during aep . The bad part is a tremendous # will be losing , gaining , losing , gaining Medicaid . Means constant nonstop chasing that greased watermelon. Also in 25 they can change plans monthly . Take into account every state will one day manage dsnps it's not a mkt id focus on in the yrs to come

 

[ValeRosso]

Also in 25 they can change plans monthly . Take into account every state will one day manage dsnps it's not a mkt id focus on in the yrs to come

Um...wut? When did this happen and where was it stated?

 

[DonP]

Um...wut? When did this happen and where was it stated?

I thought it was only integrated dsnps that could change monthly but I was wrong . I've read at least 10 articles that all dsnp and lis can move plans monthly in 25

 

[GoPokes]

Im running into a lot of QI on the medicare savings program, however I can't find a single carrier that allows a QI into their DSNP plans, they always have to be enrolled in a standard MAPD plan. Is this typically the case?

Also, if a QI is on a regular MAPD, the only benefit with this is them getting extra help, right? How do you estimate drug costs with a QI?

Technically, the extra help benefit is provided through the LIS, which is separate from the MSP QI, so they get that with PDP of MAPD.

Like yourself, I have not found any DSNP that accept QI level of MSP, unfortunately

 

[Special Agent]

Technically, the extra help benefit is provided through the LIS, which is separate from the MSP QI, so they get that with PDP of MAPD.

Like yourself, I have not found any DSNP that accept QI level of MSP, unfortunately

Here's one from Aetna that accepts q1 page 2

https://www.aetna.com/medicare/documents/individual/2024/summaryofbenefits/Y0001_H1609_045_DS08_SB24_M.pdf?&redirect=akamai

here's another one from UHC page 21

https://www.aarpmedicareplans.com/alphadog/UHFL24HP0123131_001

 

[straightnochaser]

UHC has a partial medicaid plan in most counties with a D-SNP - Look for the V-00 plans

 

[straightnochaser]

Here's one from Aetna that accepts q1 page 2

https://www.aetna.com/medicare/documents/individual/2024/summaryofbenefits/Y0001_H1609_045_DS08_SB24_M.pdf?&redirect=akamai

here's another one from UHC page 21

https://www.aarpmedicareplans.com/alphadog/UHFL24HP0123131_001

That Aetna plan is great for someone who is partial, I probably wouldn't put them in the UHC plan as it has much higher copays ($1,780 for a hospital stay!)

 

[jack3454]

Here's one from Aetna that accepts q1 page 2

https://www.aetna.com/medicare/documents/individual/2024/summaryofbenefits/Y0001_H1609_045_DS08_SB24_M.pdf?&redirect=akamai

here's another one from UHC page 21

https://www.aarpmedicareplans.com/alphadog/UHFL24HP0123131_001

Thank you