Dueling benefits

In my role, I often find myself educating clients who have both Medicare and Medicaid, commonly referred to as Duals, about their current benefits and any upcoming changes they may experience. Many people are unaware that their government entitlements are income-driven. For instance, not everyone reads their mail or understands how to interpret income tables and determine where they fall within the eligibility criteria. Typically, benefits for Duals are determined based on income, but there are exceptions determined by the government.

Recently, I had the opportunity to assist a client who experienced a significant increase in their social security benefits, going from $900 to $2,300. This change had a profound impact on their Medicaid coverage, which they had been receiving in full for years. As a result, they were now facing co-pays and had to pay for their Part B Medicare premium. Understandably, the client was confused and concerned about these sudden changes, especially considering their increasing cost of living.

With the client's permission, I carefully reviewed their mail and explained the content to them. We discovered that the income threshold for the lowest level of Medicaid was $1,600, and with the client now receiving $2,300, they exceeded the limit. This realization meant that we needed to explore alternative Medicare Advantage plans due to their current plan being discontinued. As a community resource, my role involves more listening than talking, so I took the time to understand their concerns and provide guidance accordingly.

By the end of our conversation, the client had a deeper understanding of why their benefits had changed, why they needed to switch Medicare Advantage plans, and the importance of having a hospital indemnity plan. They expressed their gratitude, considering me not just as a salesperson but also as a friend. It is always my goal to leave my clients in a better position than when I found them, and I'm glad I could make a positive impact in this case.