Medicare/Medicaid "Full-Dual" Eligibility To "Spend-Down" Special Election Question...

[InsuranceGuy29]

I have very little experience with Medicaid recipients, but I got a call from a guy who was fully dual eligible for Medicaid, and also has had Medicare (due to a disability) for quite some time.

He just got booted off his "full dual" Medicaid status and he now has a spend down of $280 before his Medicaid kicks in, every month, and he needed a Medicare Advantage policy.

He said that he called Medicaid and they put him in contact with a newer low quality carrier with horrible star ratings that he no longer wants, after doing some research of his own.

It's scheduled to go into effect on September 1st. Is there a special election period I can use to get him a different Medicare Advantage plan on September 1st, or even October 1st, if need be?

From my understanding, since he lost his full dual Medicaid status, they used that special election of losing full-dual Medicaid status to get him his current future-effective Medicare Advantage plan.

Just kinda confused. Ideally, I'd like to just get him off this plan, and onto a new plan, on September 1st. Thanks in advance.

 

[DonP]

I have very little experience with Medicaid recipients, but I got a call from a guy who was fully dual eligible for Medicaid, and also has had Medicare (due to a disability) for quite some time.

He just got booted off his "full dual" Medicaid status and he now has a spend down of $280 before his Medicaid kicks in, every month, and he needed a Medicare Advantage policy.

He said that he called Medicaid and they put him in contact with a newer low quality carrier with horrible star ratings that he no longer wants, after doing some research of his own.

It's scheduled to go into effect on September 1st. Is there a special election period I can use to get him a different Medicare Advantage plan on September 1st, or even October 1st, if need be?

From my understanding, since he lost his full dual Medicaid status, they used that special election of losing full-dual Medicaid status to get him his current future-effective Medicare Advantage plan.

Just kinda confused. Ideally, I'd like to just get him off this plan, and onto a new plan, on September 1st. Thanks in advance.

Yes you can use sep for loss of Medicaid . Almost 100% he still has lis so you can also use mde lis sep quarterly . You can use either of those seps during Aug for sep 1 or sept for Oct 1

 

[Special Agent]

Yes you can use sep for loss of Medicaid . Almost 100% he still has lis so you can also use mde lis sep quarterly . You can use either of those seps during Aug for sep 1 or sept for Oct 1

I have very little experience with Medicaid recipients, but I got a call from a guy who was fully dual eligible for Medicaid, and also has had Medicare (due to a disability) for quite some time.

He just got booted off his "full dual" Medicaid status and he now has a spend down of $280 before his Medicaid kicks in, every month, and he needed a Medicare Advantage policy.

He said that he called Medicaid and they put him in contact with a newer low quality carrier with horrible star ratings that he no longer wants, after doing some research of his own.

It's scheduled to go into effect on September 1st. Is there a special election period I can use to get him a different Medicare Advantage plan on September 1st, or even October 1st, if need be?

From my understanding, since he lost his full dual Medicaid status, they used that special election of losing full-dual Medicaid status to get him his current future-effective Medicare Advantage plan.

Just kinda confused. Ideally, I'd like to just get him off this plan, and onto a new plan, on September 1st. Thanks in advance.

Something doesn't add up if his spend down is only 280 that means his income is only about 580 which is full medicaid level unless he has liquid assets now over 9400? If he lost SSI for having more than 2000.00 in assets it could be that his medicare savings program is not through social security anymore and now he has to apply for medicare savings program through the state.

 

[AgentGeneral]

What Don said.

What the other dude said, I'm not even gonna touch....other than to say wrong info. I suspect he's a bot. or one helluva stoned agent.

If state autoenrolled theres a SEP for that too, and I'm assuming medicaid enrolling would qualify for that one as well.

 

[Special Agent]

What Don said.

What the other dude said, I'm not even gonna touch....other than to say wrong info. I suspect he's a bot. or one helluva stoned agent.

If state autoenrolled theres a SEP for that too, and I'm assuming medicaid enrolling would qualify for that one as well.

This is why some MA members can't have nice things.Do you work with dual eligibles? Do you know that the spend down or cost share dollar amount is not a number that is pulled out of thin air? it is based on a dual eligibles income -200.00 so in this case his income must be about 580.00.If it were me after more than 30 years in the biz the first thing i want to find out is why is this dude losing medicaid if he only makes about 580 a month or why is he lying to me about his cost share amount.If he only makes 580.00 a month than he qualifies for SSI.Why doesn't he have that and if he does have SSI then there is a chance that his medicaid is funding through the federal gov. and not the state.maybe there was a change on who funding is medicare savings program and that is confusion.Sometimes a person can have fm medicare savings program fund through social security and if you use the typical medicaid verification portals they are only tied in to the state eligibility data

put this dude on a less than optimal plan for his eligibility level and agents like me will come behind you and get shit straightened out

 

[AgentGeneral]

That formula youre using doesn't translate here.

Ok, you posted in another thread also that makes zero sense at least it owuld not apply in my state.

Id love to see you try to come behind me and try to fix it your way. Wouldn't happen

 

[AgentGeneral]

And yes, all the time I work with Dual---DHHS loves me here, they load me up with a ton of apps, envelopes with non postage needed app, tons of brochure for other programs.....

I won't argue with you and do not know what state your in but state medicaid is not the same from state to state, but you alluded to incorrect info in another thread to Jack oo and he ws actually believeing you. Spend down here with a 280 doesn't mean an income of 580 in any cases I've seen and yes I look at their income.

Do you know what state he is in? states vary.

There were other wrong pieces info in the jack thread as well. Like MSP is his medicaid plan. Or my favorite. When he goes on Medicare his medicaid is cancelled. THat's not the case.

Medicaid becomes secondary and medicare primary. Hence being referred to as DUAL. It's actually the state DHHS that determines eligibility on MSP, so that's wrong too. Never once heard SS has anything to do with MSP, its Extra Help/LIS that Ss where they apply only. not MSP... I have no idea how you claim to be 30 yrs in and not realize how giving agents wrong info helps in any way.


If I"m wrong prove it and enlighten me. Im open to hear it and will respond tomor

 

[Special Agent]

That formula youre using doesn't translate here.

Ok, you posted in another thread also that makes zero sense at least it owuld not apply in my state.

Id love to see you try to come behind me and try to fix it your way. Wouldn't happen

what state do you work in? All state medicaid programs have a formula for determining share of cost amount and all the ones i am familiar with it is total income - apox 200.00

 

[AgentGeneral]

I don't know the formula to be transparent but I always know their income SSI. Never seen one at 200 with 560 income. And I get you were questioning that.

But more like it the Jack post was worse on misinformation. But tired now and don't care to address it much.

Here with 200 spend downs I see more like over 1200 SSDI income.

Another thing is not only do I do this every week as much as I want to get away from it, I can't not help the people who call. I have three family members Dual as well. None have spendowns at 200, not even one younger guy who have 1240 in SSDI. He has zero spend down

This is why I can't figure the formulary out. I have people on medicaid spend downs with a waiver and no spenddown in the 1600 range and see some around 1400 with a 1600 spend down. I have no idea what the deal is....almost none have ANY assets to speak of....unless you count a car worth 4000

Care to share your formulary if it's so set in stone throughout the country as uniform.

 

[InsuranceGuy29]

I don't know the formula to be transparent but I always know their income SSI. Never seen one at 200 with 560 income. And I get you were questioning that.

But more like it the Jack post was worse on misinformation. But tired now and don't care to address it much.

Here with 200 spend downs I see more like over 1200 SSDI income.

Another thing is not only do I do this every week as much as I want to get away from it, I can't not help the people who call. I have three family members Dual as well. None have spendowns at 200, not even one younger guy who have 1240 in SSDI. He has zero spend down

This is why I can't figure the formulary out. I have people on medicaid spend downs with a waiver and no spenddown in the 1600 range and see some around 1400 with a 1600 spend down. I have no idea what the deal is....almost none have ANY assets to speak of....unless you count a car worth 4000

Care to share your formulary if it's so set in stone throughout the country as uniform.

It also doesn't help that I'm in the state of Illinois, and particularly Cook (Crook) County....Chicago's County. This state, and more specifically...county....and even more specifically....city, is run like an absolute clown show circus. Nothing makes sense.

The government administrators have no clue what's going on. They're also overburdened with cases, understaffed, can't be fired (because they all got these cushy jobs from friends and family members), and most couldn't care less.

I have one extended family member on SNAP food benefits, and her benefit amount changes almost every single month, despite nothing of hers changing. It makes no sense.

So don't read too much into the formula of how they figure these things. Whenever the state, county, or city needs more money, they just reduce benefits.

I also work the under-65 insurance marketplace, and I've got people getting Medicaid determinations 11 months after they applied for marketplace insurance. It's insane.