Another LEP

[ValeRosso]

Looking for some advice on Late Enrollment Penalties that I seem to keep getting for clients who signed up for medicare.

Recent one: Husband wanted off his wife’s group coverage starting 2023. He is 68, and has part A. Had his wife get the CMS L564 signed by her HR at the medical office she works at for her husband, and form 40B, and both were sent into local SS Office. This was near the middle of November 2022.

When I got notification he received his new Medicare cards with Part B, I enrolled him in the MAPD he chose for Jan 1st coverage. A couple of days ago I Received a message with a picture of the letter from his MAPD plan, stating he owes a $14 LEP starting Jan 1st.

His wife said he has been on her group plan for the last 10 years. What am I doing wrong? Why do my new to medicare enrollees seem to get these LEP letters? One of them was a fax quality issue, which I understand. Could this possible be a delay in communication between medicare/CMS and the health care plan, because he’s new to Part B? How should I help resolve this LEP? I did call the MAPD plan, I get generic information about submitting a form (L564 equivalent) to them, but I explained they already sent this to the SS Office.

Thank you!

 

[LostDollar]

Caveat, I am not an agent. I am a Medicare Beneficiary.

I cannot speak to MAPD's because I don't know about them.

In my experience, in the Original Medicare + Medigap + PDP world, sending the L564(s) (a person can have more than one) to Social Security does NOT mean the information is transferred to the Prescription Drug Plan. The creditable drug coverage between the time the Medicare Beneficiary turns 65 and the time of their application to the PDP will have to be documented separately to the PDP. They (PDP) will have a form for it, or sometimes they will have a phone call procedure where the PDP applicant can call the plan's customer service department and give them the information verbally.

Based on your comments above, it sounds like the MAPD's work the same way.

My opinion - It is not anything you are doing wrong, it is just the way the separate Social Security and Medicare Part C-Part D application systems work.

 

[sshafran]

As LD mentioned (sometimes he says correct things), the bene didn't fill out their attestation form the carrier sent to them.

For PDP and MAPD there is an attestation of prior creditable coverage form that gets sent out - they need to complete it.

 

[ValeRosso]

Caveat, I am not an agent. I am a Medicare Beneficiary.

I cannot speak to MAPD's because I don't know about them.

In my experience, in the Original Medicare + Medigap + PDP world, sending the L564(s) (a person can have more than one) to Social Security does NOT mean the information is transferred to the Prescription Drug Plan. The creditable drug coverage between the time the Medicare Beneficiary turns 65 and the time of their application to the PDP will have to be documented separately to the PDP. They (PDP) will have a form for it, or sometimes they will have a phone call procedure where the PDP applicant can call the plan's customer service department and give them the information verbally.

Based on your comments above, it sounds like the MAPD's work the same way.

My opinion - It is not anything you are doing wrong, it is just the way the separate Social Security and Medicare Part C-Part D application systems work.

Thank you for this, it seems like I was missing part of the process, or at least not informing the client that this was necessary.

 

[ValeRosso]

As LD mentioned (sometimes he says correct things), the bene didn't fill out their attestation form the carrier sent to them.

For PDP and MAPD there is an attestation of prior creditable coverage form that gets sent out - they need to complete it.

Thank you, I was under the assumption SS would notify the plan that a person is/isn’t due for a LEP via the forms received (L564, etc). Didn’t know a separate attestation was needed.

So my process is good, just need to let them know this other form is needed.

 

[TwoCents]

1. Form L564 -- just because someone had employer coverage doesn't mean any drug coverage with it was creditable. This form is basically used to determine if someone qualifies for a Part B SEP to enroll. I don't have insight into the Part B LEP determination.

2. As previously stated, if someone is enrolling into a Part D plan for the first time and the enrollment is past their IEP, then they should expect to receive a creditable coverage attestation form from the plan. This needs to be completed and returned (or the info usually can be called in).

3. If the client missed the attestation form and receives a letter saying an LEP has been assessed, there's usually a small window of time where they can still provide the info to the plan instead of having to go through the appeal process with the CMS contractor so it's worth a call from the client to the plan when this happens.

 

[ValeRosso]

1. Form L564 -- just because someone had employer coverage doesn't mean any drug coverage with it was creditable. This form is basically used to determine if someone qualifies for a Part B SEP to enroll. I don't have insight into the Part B LEP determination.

2. As previously stated, if someone is enrolling into a Part D plan for the first time and the enrollment is past their IEP, then they should expect to receive a creditable coverage attestation form from the plan. This needs to be completed and returned (or the info usually can be called in).

3. If the client missed the attestation form and receives a letter saying an LEP has been assessed, there's usually a small window of time where they can still provide the info to the plan instead of having to go through the appeal process with the CMS contractor so it's worth a call from the client to the plan when this happens.

thank you very much for the breakdown, it makes sense now.