Appeal?Retiree plan was to stop plan 10/31/17, but re-enrolled, kicked out client's plan

[yorkriver1]

Can this be reversed? How to appeal is the question. Client spoke to the retiree benefits dept who promised the coverage would end 10/31/17. Client received letter from her PDP plan we wrote that the retiree coverage was renewed for 2018, and her enrollment for 2017 was kicked out.
My client has the not so great MAPD option for retiree coverage, an MAPD with some pretty comprehensive Rx coverage for about $233/month, over $3K max out of pocket and typical MAPD copays for most services. Pretty good coverage for retiree with tons of expensive meds, not so much if not on many at all.
Switched to Med/Supp plan G + PDP, less cost, more coverage. I don't encourage many retirees to drop retiree coverage, but this one seems OK.
Any experience with reversing an error in enrollment?

 

[WCMason]

This exact thing is happening in Texas with TRS (Teacher Retirement System) benefits. They went from three plan choices to one MAPD for all in 2018. $135 for the retiree, $394 for the spouse. I've moved lots of teachers, and even more spouses, to a med supp and Rx plan, though some I've moved to non-retiree MAPD plans.

Reverse of the normal way these things work, where the new enrollment replaces the old, the new PDP or MAPD app is being rejected in many of these cases. This is because the notarized termination letter the retiree has to turn in to TRS isn't getting processed and passed on to next year's retiree carrier in timely way (no doubt due to their being overrun with term requests). The old is blocking the new instead of the new replacing the old.

I have resubmitted apps on some where I have confirmation their retiree plan has been canceled for 1/1 and they have gone through. I'm expecting many others will need to be resubmitted. And, of course, they're all panicked because they believe they have a 12/7 deadline when they get notified the new enrollment was rejected, which they don't have due to this being an SEP-LEC situation. Now that we know this is the way it's working I'm not submitting new apps until we're sure the retiree plan termination has been processed.

Your only solution may be to get the client to verify the retiree plan's carrier has been canceled their enrollment, and resubmit.

 

[yorkriver1]

Thanks, very helpful! We have a situation where the client has been covered by the MedSupp since 11/1/17, and I am concerned about claims getting bounced if submitted to Medicare. She doesn't want to owe the $233/month for the retiree plan and have also paid for the supplement. About enrolling for 2018, agreed, as I was telling the client, we don't have the 12/7/17 deadline, because, as you said, SEP LEC. It's the claims, and there may be some, for November and December that are an issue.
Did you have any where claims and coverage were an issue? I see what you are saying about waiting to confirm the coverage is cancelled before enrolling in the new coverage. That does seem the best if not perfect option. Unfortunately on this one the timeline for that was not long at all. Essentially word given by someone at the prior employer's benefits office that "it would be cancelled 10/31/17".
We will have some bumpy times here getting this straight.

 

[WCMason]

Thanks, very helpful! We have a situation where the client has been covered by the MedSupp since 11/1/17, and I am concerned about claims getting bounced if submitted to Medicare. She doesn't want to owe the $233/month for the retiree plan and have also paid for the supplement. About enrolling for 2018, agreed, as I was telling the client, we don't have the 12/7/17 deadline, because, as you said, SEP LEC. It's the claims, and there may be some, for November and December that are an issue.
Did you have any where claims and coverage were an issue? I see what you are saying about waiting to confirm the coverage is cancelled. Unfortunately on this one the timeline for that was not long at all. Essentially word given by someone at the prior employer's benefits office that "it would be cancelled 10/31/17".

Unless that retiree MAPD can be retroactively canceled the only option will be to reset the Med supp start date to coincide with the date it does get canceled. If it isn’t neither Medicare nor the Medigap will pay any claim.

You don’t want your client paying both and you don’t want to be the agent on a Med supp app for someone with an active MAPD in place, as defensible as your reason would be. And though it could happen, I wouldn’t hold out much hope that the MAPD will get retroactively canceled.

 

[TwoCents]

Unless that retiree MAPD can be retroactively canceled the only option will be to reset the Med supp start date to coincide with the date it does get canceled. If it isn’t neither Medicare nor the Medigap will pay any claim.

You don’t want your client paying both and you don’t want to be the agent on a Med supp app for someone with an active MAPD in place, as defensible as your reason would be. And though it could happen, I wouldn’t hold out much hope that the MAPD will get retroactively canceled.

Agreed. If the client has a letter from the PDP carrier saying the enrollment was accepted by CMS for the 11/1/17 start date, she should also have a letter saying the coverage was cancelled once the group MAPD went back into effect. Did the group go back into effective for Nov 1 or Jan 1? If Nov 1, I would call CMS and file a complaint against the carrier and request that the PDP be reinstated back to 11/1.

 

[yorkriver1]

Agreed. If the client has a letter from the PDP carrier saying the enrollment was accepted by CMS for the 11/1/17 start date, she should also have a letter saying the coverage was cancelled once the group MAPD went back into effect. Did the group go back into effective for Nov 1 or Jan 1? If Nov 1, I would call CMS and file a complaint against the carrier and request that the PDP be reinstated back to 11/1.

Client is going to call Medicare tonight. Client already received a letter yesterday from the retiree dept. that they requested coverage cancelled for 10/31/2017. There was an acceptance letter from the PDP she signed up for with me for 11/1/17, then the notice of cancellation for 11/30/17, due to the other plan. Thanks, this helped clarify next steps.
Oh, and I gave info to area manager for the PDP carrier, their research shows CMS still has other (retiree plan) carrier in the system.
WC, if you see this, are you get involved with communicating with the retiree plan office? I am second hand at this point, coaching client, who is pretty competent with business affairs. Was a manager for a long time.