AUTO ENROLLMENT IN PDP

Feb 25, 2019

  1. margostl
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    margostl Expert

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    Client called back today after speaking with Medicare.Looks like they( Medicare) auto-enrolled her in 07/2018 4months after her IEP. She cancelled and they are to send her a confirmation letter of same.I instructed her to send the confirmation to SS with the bill.
    I hope this is an isolated incident, because they have generated unnecessary work for me to resolve something that should not have occurred in the beginning.I sell PDP @ every
     
  2. margostl
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    margostl Expert

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    to every client that needs a PDP .
     
  3. alphawave2k
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    alphawave2k Super Genius

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    It looks like Medicare auto-enrolls folks that qualify for Medicaid, or LIS. Just signed a client that I helped file for their Medicaid and as soon as we got notification that he was accepted, signed him up for a DSNP.
    A week later or so, he gets a letter and his Rx card from Silver Scripts which he did not enroll for, so auto-enrolled. We'll have to got through the same process apparently. I thought that signing up for a MAPD automatically dis-enrolls them from the PDP. They are both happening simultaneously, so hopefully a call to Medicare takes care ot it.
     
  4. fun2drum
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    fun2drum Expert

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    CMS will enroll a member who qualifies for LIS or Medicaid into a PDP as standard procedure, and that's to make sure they've got a drug plan to work with their subsidy. Assuming the member chooses a different plan then that PDP is replaced by whatever plan they chose, so assuming that you got your DSNP app in after their PDP then the DSNP will be the one that takes effect.

    Edit: One more thing I forgot to point out is that it's not uncommon for your member to receive the PDP card even though it's being replaced by the MAPD. Those applications go through and the PDP company must still follow through with sending the ID card, welcome letter, etc., because they often don't know they're being replaced until much later. I've seen this happen many many times.
     
    Last edited: Mar 11, 2019
  5. alphawave2k
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    alphawave2k Super Genius

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    Key words highlighted above. Is it the chicken or the egg? I mentioned almost simultaneously, therefore I am not sure in the sequence what came first. Again, my hope is that the member simply calls Medicare and spends a 1/2 day :-( waiting to talk to someone that can help them straighten this out, and be done with it.
     
  6. TwoCents
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    TwoCents Guru

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    PDP auto-assignments are processed by CMS/plans with an application date that won't interfere with any other application that the client might complete to choose a plan so order of events is a non-factor.
     
  7. alphawave2k
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    alphawave2k Super Genius

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    Meaning that MAPD trumps PDP application? That's what I'm still trying to nail down...does the client now have to call CMS/Medicare and request dis-enrollment from PDP, or is it automatic once MAPD has been applied for?
     
  8. TwoCents
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    If it's a true PDP auto-assignment due to LIS/Medicaid, then the MAPD app should always trump the PDP. If the person wants to avoid future auto-assignment, they should first contact the PDP carrier and request an "opt out." Then apply for the MA/MAPD.
     
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