Lost dual status and looking for a better plan

[Lott Dod]

Curious, what will make you ineligible for Medicaid and Medicare? My friend lost his full dual status and now must spend around $300 monthly before Medicaid kicks in. he's being put into a plan that won't cater to all of his needs and it starts in a few days. To get him out of it, should we change it now? we need better coverage! thanks.

 

[CareCardCrew]

Looks like your friend might have lost those extra benefits because their income or assets changed. When Medicaid requires a spend-down, you often lose those extra D-SNP benefits and end up paying more out-of-pocket. The bright side is that people with dual eligibility can usually switch plans monthly using a Special Enrollment Period.

I'd suggest calling the current plan to see if there's a waiting period or if they can switch sooner. Have you looked into other D-SNPs or Medicare Advantage plans nearby?

 

[N.Marie15]

Curious, what will make you ineligible for Medicaid and Medicare? My friend lost his full dual status and now must spend around $300 monthly before Medicaid kicks in. he's being put into a plan that won't cater to all of his needs and it starts in a few days. To get him out of it, should we change it now? we need better coverage! thanks.

I would also explore the SEP option like @CareCardCrew mentioned.. If he lost Medicaid eligibility, he might qualify to switch plans outside the standard enrollment windows. Also try contacting your State Health Insurance Assistance Program. They can provide free, unbiased counselling on Medicare and Medicaid and can guide you through finding a better plan for your specific needs. Hope you get to sort this out soon!

 

[Riry Jones]

The dual-eligibility system is a mess. One wrong income report or paperwork delay, and people lose crucial benefits. It's ridiculous that seniors have to game-plan like stockbrokers just to get basic healthcare coverage