Marketing Dual Eligibles for Medicare Advantage

[yogooglethis]

I need to revamp this marketing in IL. The state stepped in and is giving all duals over to HMO companies. Now I need to market LIS.

I have not found a good way to do this yet. If anyone has I would like to hear about it and maybe talk. Thanks.

In Florida as of 5/1/14 if a full dual wasn't already enrolled in a snp ma plan the state gave then the choice of 4 different " MMA " Medicaid HMO plans. However in Florida anyway the MMA plans are only managing the portion of the bill that Florida fee for service Medicaid was previously paying to providers for service's provided to duals -which is usually nothing since a provider can't balance bill a dual for Medicare covered services.

They can still decide to enroll in an a DE SNP MA instead and it has been a boon for us that sell the UHC Dual SNP RPPO since the biggest complaint by the duals has been losing access to their providers who are not par in the MMA HMO networks and having to get referrals for the first time ever. On the PPO SNP they still can't be balanced billed by OON providers for Medicare covered services however the provider has to be willing to take 70% of Medicare rates instead of the 80% they were getting for their dual patients using Medicare

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I need to revamp this marketing in IL. The state stepped in and is giving all duals over to HMO companies. Now I need to market LIS.

I have not found a good way to do this yet. If anyone has I would like to hear about it and maybe talk. Thanks.

In Florida as of 5/1/14 if a full dual wasn't already enrolled in a snp ma plan the state gave then the choice of 4 different " MMA " Medicaid HMO plans. However in Florida anyway the MMA plans are only managing the portion of the bill that Florida fee for service Medicaid was previously paying to providers for service's provided to duals -which is usually nothing since a provider can't balance bill a dual for Medicare covered services.

They can still decide to enroll in an a DE SNP MA instead and it has been a boon for us that sell the UHC Dual SNP RPPO since the biggest complaint by the duals has been losing access to their providers who are not par in the MMA HMO networks and having to get referrals for the first time ever. On the PPO SNP they still can't be balanced billed by OON providers for Medicare covered services however the provider has to be willing to take 70% of Medicare rates instead of the 80% they were getting for their dual patients using Medicare

 

[yorkriver1]

Which state are you in? There is a similar situation in calif right now. Lots of question marks as to whether these MA enrollees will be swiped over without compensation to the agent.

Virginia. No commission paid for QMB+, and cannot discuss the new plans with clients, or will be sanctioned by BOI, possibly lose appointment with existing carrier. We don't have a massive # of this category in our state, but some agents are losing a pretty significant % of their book. Not that it will work that way in other states, the description of Florida sounded encouraging.

 

[wehotex]

The FMO's I have talked to feel the agent will get paid even when they switch to non agent involved HMO's.

I know I should consider the source.

What do other think ?

Yes, Please DO consider the source. The worthless FMOs want you to do all of the digging so they can reap a portion of the reward of your blood, sweat and tears. They lose nothing if you go out and do of the work.

I was told that CareFirst and LA Care have put it in writing that they WILL continue to pay renewals when the switchovers take effect. HealthNEt has only agreed verbally and not in writing.

 

[GreenSky]

I think we're good through 2015. After that they plans will be changed to state plans. The insurance companies will have no issue saving $250 by not paying us.

Rick

 

[goillini52]

In Florida as of 5/1/14 if a full dual wasn't already enrolled in a snp ma plan the state gave then the choice of 4 different " MMA " Medicaid HMO plans. However in Florida anyway the MMA plans are only managing the portion of the bill that Florida fee for service Medicaid was previously paying to providers for service's provided to duals -which is usually nothing since a provider can't balance bill a dual for Medicare covered services.

They can still decide to enroll in an a DE SNP MA instead and it has been a boon for us that sell the UHC Dual SNP RPPO since the biggest complaint by the duals has been losing access to their providers who are not par in the MMA HMO networks and having to get referrals for the first time ever. On the PPO SNP they still can't be balanced billed by OON providers for Medicare covered services however the provider has to be willing to take 70% of Medicare rates instead of the 80% they were getting for their dual patients using Medicare

MMA, HMO, DE, SNP, MA, UHC, RPPO, PPO, OON........Damn that's a lot of abbreviations and acronyms!

 

[fishfortwo]

Here in Virginia it is a pilot program. If they are QMB+ they have a choice of three carriers. If they do not choose one they will be auto assigned. I have lost about $400 a month so far. When my clients call me I cannot give them any advice on what to do. We have been severely warned that we will be investigated if they see people not moving to one of the plans. I know of one agent that is happening to right now. I wrote about 6 in AEP that I really did not want to write as I had a feeling this was going to happen, I was charged back for all of them even after I was told that would not happen. I am losing at least one to three a week. There go all of those continuing commissions. I have a feeling this will probably spread if this is successful to other levels of assistance.

 

[wehotex]

Here in Virginia it is a pilot program. If they are QMB+ they have a choice of three carriers. If they do not choose one they will be auto assigned. I have lost about $400 a month so far. When my clients call me I cannot give them any advice on what to do. We have been severely warned that we will be investigated if they see people not moving to one of the plans. I know of one agent that is happening to right now. I wrote about 6 in AEP that I really did not want to write as I had a feeling this was going to happen, I was charged back for all of them even after I was told that would not happen. I am losing at least one to three a week. There go all of those continuing commissions. I have a feeling this will probably spread if this is successful to other levels of assistance.

Were you told "verbally" or was it in writing? Since you say "told", I assume that it was only verbal.

 

[fishfortwo]

I was on a conference call with one of the carriers, so I and other agents heard this as well. They claim they are still working on something for the agents as CMS has denied them to compensate us for the chargebacks after the conference call.