So are all dual eligible people forced into some crappy Advantage plan or coordinated care (CCO) plan? I'm specifically asking about Oregon. I want help paying my Medicare premium, but want to keep original Medicare.
Great question David. You are not FORCED nor REQUIRED to go on a Medicare Advantage just because you qualify for Medicaid. However, most folks on Medicaid can't afford to stay on OM only with a Supplement. There are different levels of Medicaid, so depending on what level you are on will determine what benefits are provided, such as Part B premium assistance. With that said, most also choose Med. Adv. with Medicaid because some of those plans include Part B premium reduction, Flex spending card and a lot of other benefits that may not be covered by Medicare. We offer both types of plans - so, I am not biased one way or another. Hope you found this helpful.
@@medicarewithmelissa Those Advantage plans also come with provider networks and prior authorization. Meaning.... The insurance company can deny you medical tests, procedures, and treatments! And if the doctor you want isn't in the network, you pay more or all of the costs! In my opinion, that outweighs the above mentioned benefits.
@@medicarewithmelissa The reason I asked the question is that when I went to apply online, at the end of the application, it asked me to pick a coordinated care (CCO) plan, and refused to let me proceed unless I chose one. I paused the application to do further research. I read that almost everyone on Oregon Medicaid must be in a CCO. That would be unacceptable to me if it were correct. Tried to call the state but gave up after being on hold for 45 minutes.
@@medicarewithmelissa Thanks. So it comes down to.... Can I get help from Oregon in paying for my Medicare part B premium or my Supplemental plan G without all the other unwanted stuff?
Hello, I have a question. I used to have CA EAE DSNP Medicaid. Let me explain. Later I changed to Aetna and when I returned to Molina Healthcare, they assigned me to the Molina version of CA EAE DSNP Medicare, but I don't understand why, if my Medicaid is still active and now I no longer receive my transportation services, I don't understand. Could you please explain this to me and thank you.
Hi Melissa. Thank you for making this video. I subscribed and hope you can get to 1,000. I just reached 1,000 and that's why I need to talk to you. I'm dual eligible and need help understanding income and asset limitations before I make a big mistake.
Thanks for watching. I am traveling this week, but happy to help. Income and asset limitations can vary by state. Also, there was a big shakeup in Medicaid eligibility recently. What state are you in?
I have a medicare advantage SNP dual eligible plan and it is horrible. Nothing ever gets accomplished. Constantly getting bills that i have to figure out why this wasnt paid or why my portion was not submitted to my secondary which is Medi-ca! In california. Most of the providers in the snp network do not accept Medi-Cal. So why are they in my snp network if they dont even accept my california medicaid? The HMO doctors dont even look at you no matter what you are there for and just refer you to a specialist. Then you find out that a referral isnt good enough now you need an approva! From snp. Back to square one. Call the pcp and tell them to request the authorization which they say should take a week. A month goes by still no approval. Call the SNP they say they never got the request. Call the doctor they say they sent it but will resend it. Rinse and repeat. Its a nightmare! You can't get any care. Meanwhile you are sick or having pain and it simply goes untreated. Its a racket. Then theres the dreaded colonoscopy that they keep hounding everyone to get. Yeah, good luck with that. Two years in a row, two separate insurance companies did the exact same thing. You schedule the colonoscopy like months ahead because thats how backed up it is, and shortly before, and i mean shortly like a week or so before your scheduled procedure, it gets cancelled because for some reason the insurance company suddenly pulls back the authorization and wants you to reschedule at a different facility or with a different doctor. WHAT???? I waited 3 months for the procedure that they supposedly approved only to be denied at the last minute. Now you gotta start over and do it all again. Two years in a row, two different insurance companies so its pretty obvious its basically standard procedure for them to just avoid having to provide something the government says the have to pay for. Going through this now for the third time. Its never gonna get done. Even something as simple as xrays. Their provider network was not showing a facility within 100 miles where i could get them done. Ultimately went to a standard facility my pcp referred me to and my insurance is refusing to pay the bill even though i had called them 3 times and could not get an answer on where to go. Advantage plans are horrible. They spend the whole year passing you around and passing the buck and never really do anything to help you or provide the care you are paying for. They are taking government money to provide a plan that specializes in not allowing or paying for anything. Its a total scam. I have learned my lesson and I am done with Medicare Advantage.
definitely sounds like you had a bad experience with coordination of benefits and doctors, you’re not alone. dual plans can be challenging to navigate. hopefully, you have a good agent that can assist you with the moving parts. otherwise, we’re happy to help!
Tony, the dual population is underserved, although, carriers are getting better with developing dual plans. In short, there are non-dual Advantage plans that still work for dual-eligible beneficiaries. We are happy to take a look for you!
***** JUDY I NEED YOUR HELP ***** I CAME FRO COLORADO AND JUST GOT APPROVED FOR MONTANA MEDICAID. GOT AN EMAIL TELLING ME I HAD TO PICK A DOCTOR AND GET A Medicaid Passport to Health Program. I CAME HERE BECAUSE I BELIEVE IN FREEDOM OF CHOICE AND DO NOT WANT TO BE BULLIED INTO ANYTHING. DO YOU KNOW ANYTHING ABOUT THIS BECAUSE I SURE DONT. THANK YOU ANGELA IN MONTANA
Hey Melissa I'm very confused I'm 56 and I'm on Medicaid but going on Medicare 2-1-24 I was diagnosed with MS and Diabetes I satrated receiving my SSDI in April on 2023 I'm just confused they stopped my SNAP food program and now want me to start paying $105 a month for Medicaid and I start with Medicare 2-1-2024 I live in Ohio please help need advice
Hi, i am 67y old man who has Medicare Plan A. Since I lived outside of US untill recently did not apply for Plan B. Since my SS benefit is very low am I eligible for Mecidaid? Also do I need to apply and enroll in Plan B first then apply for Medicade. Thanks
Thanks for watching. You do not need to enroll in Part B prior to applying for Medicaid. Also, related to Part B and your time out of the country, you may face a penalty when applying (at least be aware to provide documents that would indicate reasons why and if you carried any form of health insurance during that time). We are happy to help with both and of course with all of our clients, no cost. 866-633-4427
So are all dual eligible people forced into some crappy Advantage plan or coordinated care (CCO) plan? I'm specifically asking about Oregon. I want help paying my Medicare premium, but want to keep original Medicare.
Great question David. You are not FORCED nor REQUIRED to go on a Medicare Advantage just because you qualify for Medicaid. However, most folks on Medicaid can't afford to stay on OM only with a Supplement. There are different levels of Medicaid, so depending on what level you are on will determine what benefits are provided, such as Part B premium assistance. With that said, most also choose Med. Adv. with Medicaid because some of those plans include Part B premium reduction, Flex spending card and a lot of other benefits that may not be covered by Medicare. We offer both types of plans - so, I am not biased one way or another. Hope you found this helpful.
@@medicarewithmelissa Those Advantage plans also come with provider networks and prior authorization. Meaning.... The insurance company can deny you medical tests, procedures, and treatments! And if the doctor you want isn't in the network, you pay more or all of the costs! In my opinion, that outweighs the above mentioned benefits.
@@DavidJohnson-tv2nn 100% correct across the board.
@@medicarewithmelissa The reason I asked the question is that when I went to apply online, at the end of the application, it asked me to pick a coordinated care (CCO) plan, and refused to let me proceed unless I chose one. I paused the application to do further research. I read that almost everyone on Oregon Medicaid must be in a CCO. That would be unacceptable to me if it were correct. Tried to call the state but gave up after being on hold for 45 minutes.
@@medicarewithmelissa Thanks. So it comes down to.... Can I get help from Oregon in paying for my Medicare part B premium or my Supplemental plan G without all the other unwanted stuff?
Hello, I have a question. I used to have CA EAE DSNP Medicaid. Let me explain. Later I changed to Aetna and when I returned to Molina Healthcare, they assigned me to the Molina version of CA EAE DSNP Medicare, but I don't understand why, if my Medicaid is still active and now I no longer receive my transportation services, I don't understand. Could you please explain this to me and thank you.
In short, states can auto-assign you to a plan if you are eligible for Medicaid + Medicare.
Hi Melissa. Thank you for making this video. I subscribed and hope you can get to 1,000. I just reached 1,000 and that's why I need to talk to you. I'm dual eligible and need help understanding income and asset limitations before I make a big mistake.
Thanks for watching. I am traveling this week, but happy to help. Income and asset limitations can vary by state. Also, there was a big shakeup in Medicaid eligibility recently. What state are you in?
@@medicarewithmelissa AZ. I just sent you an email
I have a medicare advantage SNP dual eligible plan and it is horrible. Nothing ever gets accomplished. Constantly getting bills that i have to figure out why this wasnt paid or why my portion was not submitted to my secondary which is Medi-ca! In california. Most of the providers in the snp network do not accept Medi-Cal. So why are they in my snp network if they dont even accept my california medicaid?
The HMO doctors dont even look at you no matter what you are there for and just refer you to a specialist. Then you find out that a referral isnt good enough now you need an approva! From snp. Back to square one. Call the pcp and tell them to request the authorization which they say should take a week. A month goes by still no approval. Call the SNP they say they never got the request. Call the doctor they say they sent it but will resend it. Rinse and repeat. Its a nightmare! You can't get any care. Meanwhile you are sick or having pain and it simply goes untreated. Its a racket.
Then theres the dreaded colonoscopy that they keep hounding everyone to get. Yeah, good luck with that. Two years in a row, two separate insurance companies did the exact same thing. You schedule the colonoscopy like months ahead because thats how backed up it is, and shortly before, and i mean shortly like a week or so before your scheduled procedure, it gets cancelled because for some reason the insurance company suddenly pulls back the authorization and wants you to reschedule at a different facility or with a different doctor. WHAT???? I waited 3 months for the procedure that they supposedly approved only to be denied at the last minute. Now you gotta start over and do it all again. Two years in a row, two different insurance companies so its pretty obvious its basically standard procedure for them to just avoid having to provide something the government says the have to pay for. Going through this now for the third time. Its never gonna get done.
Even something as simple as xrays. Their provider network was not showing a facility within 100 miles where i could get them done. Ultimately went to a standard facility my pcp referred me to and my insurance is refusing to pay the bill even though i had called them 3 times and could not get an answer on where to go.
Advantage plans are horrible. They spend the whole year passing you around and passing the buck and never really do anything to help you or provide the care you are paying for. They are taking government money to provide a plan that specializes in not allowing or paying for anything. Its a total scam.
I have learned my lesson and I am done with Medicare Advantage.
definitely sounds like you had a bad experience with coordination of benefits and doctors, you’re not alone.
dual plans can be challenging to navigate.
hopefully, you have a good agent that can assist you with the moving parts. otherwise, we’re happy to help!
What are the Medicaid laws for Alabama,for a 69yr.old on ssI,medicare and medicare?
You can find out Alabama-specific Medicaid rules here: www.medicaidplanningassistance.org/medicaid-eligibility-alabama/
We can help you file for Medicaid and then find a Medicare plan that fits for being dual-eligible (Medicare+Medicaid)
@@medicarewithmelissa I did that already, Thank you
@@judyjohnson5204 OK. What can I help with then?
I am on ssd I got Medicare can I get Medicaid to because Medicare don’t pay for everything?
thanks for watching! If you haven't applied for Medicaid in the last 12 months, you should! SSDI has no impact on your eligibility.
What if there is no diual plan available ?
Tony, the dual population is underserved, although, carriers are getting better with developing dual plans. In short, there are non-dual Advantage plans that still work for dual-eligible beneficiaries. We are happy to take a look for you!
***** JUDY I NEED YOUR HELP *****
I CAME FRO COLORADO AND JUST GOT APPROVED FOR MONTANA MEDICAID. GOT AN EMAIL TELLING ME I HAD TO PICK A DOCTOR AND GET A Medicaid Passport to Health Program. I CAME HERE BECAUSE I BELIEVE IN FREEDOM OF CHOICE AND DO NOT WANT TO BE BULLIED INTO ANYTHING. DO YOU KNOW ANYTHING ABOUT THIS BECAUSE I SURE DONT.
THANK YOU ANGELA IN MONTANA
Angela- call our office today, 866-633-4427 and ask to speak with Melissa or Amie. They will be happy to help you along.
Hey Melissa I'm very confused I'm 56 and I'm on Medicaid but going on Medicare 2-1-24 I was diagnosed with MS and Diabetes I satrated receiving my SSDI in April on 2023 I'm just confused they stopped my SNAP food program and now want me to start paying $105 a month for Medicaid and I start with Medicare 2-1-2024 I live in Ohio please help need advice
Please email or call me, and I'll be happy to spend some time with you. Info@seniorhealthcaresolutions.com , 866-633-4427
What are the protocols or rules for Chicago for Medicare and Medicaid?
Hi Christine! Medicaid is based on income and varies by state. We can help determine your eligibility and submit an application.
Hi, i am 67y old man who has Medicare Plan A. Since I lived outside of US untill recently did not apply for Plan B. Since my SS benefit is very low am I eligible for Mecidaid? Also do I need to apply and enroll in Plan B first then apply for Medicade.
Thanks
Thanks for watching. You do not need to enroll in Part B prior to applying for Medicaid. Also, related to Part B and your time out of the country, you may face a penalty when applying (at least be aware to provide documents that would indicate reasons why and if you carried any form of health insurance during that time). We are happy to help with both and of course with all of our clients, no cost. 866-633-4427
@@medicarewithmelissa thanks for your reply. Can you help me to apply for Medicaid and what is the cost? I am residing in NJ
@@erminbay here is the link to our team calendar, grab a spot that works for you. host.safemsngr.com/widget/bookings/teamshs
Andover
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