Best option for insurance

[ajwees41]

I am on Medicare and Medicaid and on managed medicaid whose contract is up with the state this year so what are my options.  Should I try getting on a dual plan my cpap supplier accepts or wait until they decide on a new managed medicaid plan and go from there?  the new contracts wouldn't even start until July 1st 2023.

[clownbell]

An interesting question. I've never been in your shoes, but I would think that if you have any (present or possible future) medical concerns other than cpap, it would seem reasonable to wait on a decision regarding the new managed Medicaid plan. In any case, Medicare should pay its typical 80% I would think.

[ajwees41]

An interesting question. I've never been in your shoes, but I would think that if you have any (present or possible future) medical concerns other than cpap, it would seem reasonable to wait on a decision regarding the new managed Medicaid plan. In any case, Medicare should pay its typical 80% I would think.

The thing is Medicare makes you you rent the machine for so long and it starts over when they replace it at the 5 year mark.  I am in the 2nd or 3rd month of the rental.

[Lucid]

Hmm, I googled Medicare Medicaid dual plans, and they sound attractive on the company website (United Healthcare was the one that came up).

It sounds as if it's like Medicare Advantage compared with original Medicare.  If that's the case, a dual plan would offer lower costs and possibly some additional benefits, but less flexibility.  I would guess that the dual plan is going to be very strict about using its own in-network providers, contractors like DMEs, drug formulary, etc.

If you are getting good service with your DME, and they're accepted by a dual plan in your area, that would seem like a good sign for that plan.  You'd also want to be sure the plan formulary covers any medications that you need, whether any doctors you depend on are in network, and so on.  Also research the reputation of the specific plan and umbrella company vis-a-vis claims denial, etc.

Medicare Advantage plans can change from year to year; perhaps the same is true of dual plans?

If you have the time, it sounds like it's well worth researching dual plan options, even if you end up deciding to wait and see what happens with the Medicaid contract.

I don't have direct experience with Medicaid.  I'm basing my suggestions mainly on analyses of Medicare options that I've read in Consumer Reports type publications (not Consumer Reports itself, though) and extrapolating.  I'm also not a doctor, nurse, or health economist, so this is not professional advice.