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

[yogooglethis]

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 recently read a letter a UHC Dual SNP member received from carrier informing member that they since they received notice from Fl medicaid that they are losing Medicaid they will be dis-enrolled in 6 month if the member didn't reinstate their Medicaid.The letter went on to say that member won't be liable for cost share in this grace period even if Medicaid is not reinstated.My guess is that this is probably a requirement that CMS imposes on the SNP MA carriers to protect these vulnerable beneficiaries who have challenges navigating the Medicaid system.

In this case the beneficiary was not going to re-qualify for Medicaid due to change in financial status as a result of a recent marriage.I had to advise client to milk it to the end and I will enroll her in a non SNP when her grace period ends using a "loss of medicaid " SEP.

 

[wehotex]

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

I have a current Amerigroup Dual mb who lost his QMB ( can't get it back) back on July 31! They still have not notified him that he must change his Dual plan. The Amerigroup Dual EOC does not have other copays, just all $0s everywhere. I dropped the ball on the one that I thought was a QI-1 getting into a CIP Dual. I looked at an old app from her previous insurance and noticed that she had FULL QMB! Ouch. Her sister that lives with her is Partial Dual. My mistake was marking them both as Partial Dual and giving her a non-dual plan for the past 4 months. My bad. She's liked me in the past. I hope that she gives the chance to get her a suitable Dual plan.

 

[WCMason]

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.

CMS requires a grace period of at least one month after loss of Medicaid eligibility before a plan can terminate a member, but plans are allowed to extend that. Then, of course, there is a two month SEP after the plan terminates to enroll in another MA plan or PDP. So that six month period you're describing is plan specific.

 

[Bob L]

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

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I'm simply stating from experience.

Things are different from one carrier to another. For example, here in Tennessee, some dual SNPs require full QMB Medicaid (e. g. Humana), whilst others, such as Cigna-HealthSpring, only require that the beneficiary be on Medicaid at any level.

Thus if a client loses his QMB status and is now SLMB (whose only Medicaid benefit is that his Part B premium is paid by the state), with C-HS, he can remain in the SNP if he chooses to do so -- normally not a good idea since he can enroll in zero-premium plans with more appropriate benefits.

I have actually enrolled a couple SLMBs who desperately wanted the transportation benefit, for example. Some of the other benefits, such as a SNF stay, which is zero copay for all 100 days, doctor visits, etc., are better than can be found in other plans, although some, such as inpatient hospital, are quite a bit worse.

Of course, the client enrolled in the TotalCare SNP only after hearing my little sermon about how I felt Preferred would be a better choice for a SLMB beneficiary in most cases, and after enduring a specific benefit-by-benefit comparison. If they made a dumb choice, they did it after being fully informed. And I always tell them if something comes up they can always call me to change plans on the first day of the next month.

 

[TwoCents]

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.

CMS outlines the timeframes for notification. To stay compliant plans must provide timely notification.