In my prior three posts, I’ve discussed the coming My Care Ohio pilot program for people on both Medicare and Medicaid (people called “dual eligibles.”) On February 21, I tried to provide an overview on how the My Care Ohio program will work (Managed care for Ohio Medicare/Medicaid “Dual Eligibles”.) On February 28, I explained how My Care Ohio is an attempt to cut costs through insurance company command and control methods rather than empowering people to choose lower cost care by making it easier to qualify for in-home care Medicaid through PASSPORT or for the Assisted Living Waiver instead of maintaining the current financial incentive to choose a nursing home, with its higher cost per person (My Care Ohio: A Triumph of the Stick over the Carrot.) On March 7, I described the decisions that dual eligibles must make when My Care Ohio comes to their county: (1) whether to accept managed care for Medicare for this first year; (2) which Managed Care Organization to join; and (3) whether to accept managed care for Medicare for years two and three. (Your Options in “My Care Ohio,” managed care for Medicare/Medicaid “Dual Eligibles”)
When deciding which options to choose among those questions, dual eligibles should consider a number of factors:
My Care Ohio is a pilot program. The dual eligibles that participate are essentially “guinea pigs.” Sorry.
My Care Ohio gives control over treatment decisions to an insurance company as a managed care organization. The insurance companies will be paid a fixed amount per person under their supervision. Treatments approved cut into the insurance company’s profit.
Medicare is the “big dog.” No matter which service providers may be on (or, more importantly, off) a Medicaid MCO’s approved list, if a dual eligible can use the service provider with his or her Medicare coverage, Medicaid (even managed care Medicaid) has to go along. (Note: Many long term care services may not fall under Medicare at all (like in-home non-skilled care.) Medicaid will have full control over those services and providers.)
My Care Ohio will probably result in a smaller number of providers staying on any one insurer’s approved list. At the same time (and unrelated,) the Affordable Care Act will probably prompt insurers to reduce their approved list of providers. So, reliance on a particular insurer may allow the insureds fewer choices of medical service providers and possibly even fewer choices in the next year.
The marketing rules for Medicare “companion” insurance (i.e., supplements and Advantage plans,) could make information from the managed care organizations available only AFTER the deadline to choose a managed care organization.
If I were choosing for myself, with the factors described above in mind, I would try to position myself for maximum flexibility to keep (or find) providers that I like as much as I possibly could.
I suggest that dual eligibles should
(1) Let the Department of Medicaid make the initial choice of the Medicaid Managed Care Organization this year (to avoid wasting time looking for information on the MCOs when that information is limited or not even available;)
(2) After the Managed Care Organizations release their information and provider lists, use the 90-day window at the beginning of year one to determine which MCO is better and change MCOs if appropriate;
(3) Opt out of managed care for Medicare. (Remember, opting out of Medicare is the default choice for year one;)
(4) Drop (don’t renew) Medicare supplements and Advantage plans when the open enrollment period arrives later this year (Remember, for these “dual eligibles,” Medicaid can pay the co-pays and deductibles for Medicare-covered services;) and
(5) Make sure to opt out of managed care for Medicare when the annual renewal of My Care Ohio comes up. (Remember, in years two and three, opting out of Medicare requires notification to the appropriate authorities.)
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