Calculating Open Enrollment

[Frank Stastny]

I believe that what this thread points out is it that is incumbent that the agent contact each carrier they represent and ask underwriting.

When contacting the carrier be sure to also ask the same question for each state you sell in. The answer may not be the same for all states the company is in.

The rules and regs can differ greatly from state to state.

 

[bourbonlegend]

Well here's a twist on this question for you all.

I'm still doing a good bit of MA. One couple that I am seeing is in a bind. They were on the wife's company health plan, but she retired in June. She had enough vacation to keep her work health insurance through the end of July, but she either has to use medicare or go on COBRA August 1.

Here's the problem. They both have red white and blue cards that show their Part A effective dates. They sent their letter of creditable coverage to medicare/ssa to get their part b effective dates, and were told that they would both have an august 1 part b effective date.

Problem is that with any marx check, neither of the two show a part b effective date. If it ain't verifiable, it doesn't exist.

So, I don't think I can enroll them in a MAPD plan effective August 1, can I?

I am appointed with Mutual of Omaha/United World. Is it possible to enroll them in the MOO med supp effective August 1? If they don't already have Part D, would this loss of creditable coverage qualify them for a Part D?

I guess I could call MOO tomorrow to find out, too.

Your clients can have AUG 1 effective date for medigap, stand alone part d or mapd based on everything you posted.

Their OE period would begin Aug 1

 

[Frank Stastny]

Med supp open enrollment obviously starts when client is both 65 and has part B.

Actually even the above statement is not always true. You state that it begins "when client is both 65 and has part B".

In Missouri the client does not have to be both 65 and have Part B. When a person who is on SS disability first receives Medicare Part A&B they will have an Open Enrollment Period.

They will have another Open Enrollment Period with they reach age 65.

This is a great place to get general information but when asking questions that relate to compliance an agent should always do their own research. The underwriters and possibly the DOI are the ones who have the last word.

I have talked to many agents who have walked away from business because they believed something someone said instead of doing their own research.

 

[jdeasy]

Well here's a twist on this question for you all.

I'm still doing a good bit of MA. One couple that I am seeing is in a bind. They were on the wife's company health plan, but she retired in June. She had enough vacation to keep her work health insurance through the end of July, but she either has to use medicare or go on COBRA August 1.

Here's the problem. They both have red white and blue cards that show their Part A effective dates. They sent their letter of creditable coverage to medicare/ssa to get their part b effective dates, and were told that they would both have an august 1 part b effective date.

Problem is that with any marx check, neither of the two show a part b effective date. If it ain't verifiable, it doesn't exist.

So, I don't think I can enroll them in a MAPD plan effective August 1, can I?

I am appointed with Mutual of Omaha/United World. Is it possible to enroll them in the MOO med supp effective August 1? If they don't already have Part D, would this loss of creditable coverage qualify them for a Part D?

I guess I could call MOO tomorrow to find out, too.

They can't get a med sup or an MA plan until they have a verifiable part B. You can go ahead and enroll them in a part D since they don't have to have to have B for that.

I wouldn't put them in an MAPD even if they had part B. I've done over 700 MA plans over the last 3 years, I can count on one hand the MAPD plans I have enrolled people in. The person has more options when you keep them separate.

These folks have 63 days from the loss of coverage to get on a part D, an MA, Medigap or MAPD. They need verifiable part B for the MA, Medigap or MAPD.

You can enroll them in an MA or Medigap using the effective date of part B that they have been told. The company will hold it and won't pay any bills until the part B is verified.

 

[motorcyclegogo]

They can't get a med sup or an MA plan until they have a verifiable part B. You can go ahead and enroll them in a part D since they don't have to have to have B for that.

I wouldn't put them in an MAPD even if they had part B. I've done over 700 MA plans over the last 3 years, I can count on one hand the MAPD plans I have enrolled people in. The person has more options when you keep them separate.

These folks have 63 days from the loss of coverage to get on a part D, an MA, Medigap or MAPD. They need verifiable part B for the MA, Medigap or MAPD.

You can enroll them in an MA or Medigap using the effective date of part B that they have been told. The company will hold it and won't pay any bills until the part B is verified.

Now maybe I'm confused. I thought that if a beneficiary enrolled in a MA and wanted a drug plan they had to enroll in a MAPD and that it was no longer possible to enroll in a MA plan and then ala carte pick a seperate PDP. Am I wrong?

 

[Frank Stastny]

Now maybe I'm confused. I thought that if a beneficiary enrolled in a MA and wanted a drug plan they had to enroll in a MAPD and that it was no longer possible to enroll in a MA plan and then ala carte pick a seperate PDP. Am I wrong?

In a word, yes.

Although I don't sell them I have certified each year. Unless they have made a change that I've not been informed of an MA can be sold as a stand alone plan without a PDP.

Personally, if I were selling MA plans I would not have written any MAPD plans. I personally do not think it would be in the client's best interest.

I would do exactly what jdeasy has done. He is presenting the plan that gives his clients the option to choose the most effective, flexible way to invest their premium dollars. Not only today but also in the future.

 

[jdeasy]

Now maybe I'm confused. I thought that if a beneficiary enrolled in a MA and wanted a drug plan they had to enroll in a MAPD and that it was no longer possible to enroll in a MA plan and then ala carte pick a seperate PDP. Am I wrong?

Yep, you are wrong on that. It is not only possible to enroll a person into a stand alone MA and a stand alone PDP, it is in the client's best interest in almost every case.

Humana doesn't have a stand alone MA, so, they be the ones that put out that info. Well, they do have that PPO now doesn't have a drug plan and you cannot have a drug plan with it.

The few MAPD's that I have done have been after I advised the client to not do it and they insisted. Now, I still wouldn't do it and would refer them to someone else. Live and learn.

 

[MedSuppPro]

Recently, a client applied for UofO and wanted to skip a month in order to save one month of premium. He was one day away from loosing his T-65 Guarantee Issue status. How could I advise someone to delay an Effective Date for 32 days?

Just like Winter, I didn't know the exact rule and my appointment was on a Sunday (MofO closed) with a two hour drive. And, I didn't want this guy to get PO'd if he got burned by delaying an Effective Date. The solution for me was to slide the application over and to have him write his requested Effective Date on his application. I explained that we can try to request "his" Effective Date and we will see if UofO will accommodate. UofO accepted his request.

As far as an hard and fast rule for or against MA + PD Vs. MAPD, the professional multifaceted MediAgent will always look at all options. In some cases MAPD's can work better then a stand alone PDP. I realize that some agent's will not take the time to comprehensively look at their client's Rx issue. It takes a lot of agent time to look at all options and the savings can be in the thousands of $'s. In some cases the Rx issue is the number one $ issue and that is why they need an professional. Yep, I've saved clients thousands of $'s by recommending MAPD prescription drug combo plan's.

How can agent's with a limited practice, whom offer limited services, make statements for or against MAPD's unless they are actually working cases. Just because one gets certified doesn't mean #@&%! Prescription drug costs can be a huge $ cost component for the senior. Some seniors are in and out of the doughnut whole within a few months. How can a true professional make such broad statements that if:... "I were selling MA plans I would not have written any MAPD plans. I personally do not think it would be in the client's best interest."? Look, we all luv ya, but, your simply wrong on this one!

Maybe we could meet at Gladstone's and sit down and have a Red Stripe beer! I'll invite Obama -- he's a Bud Man!

 

[policy doctor]

Maybe I'm working with favorable selection here, vs adverse selection. But I would like to see an illustration of a second or third tier drug and tell me the price that one drug plan would charge vs another D plan.

I still think that the formulary is pretty standard between companies, and only the copay is different. And we're talking 5/10 dollars difference. Please show me an illustration. I looked up some drugs in the past and didn't see a dramatic difference.

I also like combo's not only becaue they save on PDP premium, but even their out-of pocket (copays) are less.

Now the SNP's can offer a savings, if they qualify; esp if they are duals. However, I don't seek out that market.

 

[jdeasy]

Recently, a client applied for UofO and wanted to skip a month in order to save one month of premium. He was one day away from loosing his T-65 Guarantee Issue status. How could I advise someone to delay an Effective Date for 32 days?

Just like Winter, I didn't know the exact rule and my appointment was on a Sunday (MofO closed) with a two hour drive. And, I didn't want this guy to get PO'd if he got burned by delaying an Effective Date. The solution for me was to slide the application over and to have him write his requested Effective Date on his application. I explained that we can try to request "his" Effective Date and we will see if UofO will accommodate. UofO accepted his request.

As far as an hard and fast rule for or against MA + PD Vs. MAPD, the professional multifaceted MediAgent will always look at all options. In some cases MAPD's can work better then a stand alone PDP. I realize that some agent's will not take the time to comprehensively look at their client's Rx issue. It takes a lot of agent time to look at all options and the savings can be in the thousands of $'s. In some cases the Rx issue is the number one $ issue and that is why they need an professional. Yep, I've saved clients thousands of $'s by recommending MAPD prescription drug combo plan's.

How can agent's with a limited practice, whom offer limited services, make statements for or against MAPD's unless they are actually working cases. Just because one gets certified doesn't mean #@&%! Prescription drug costs can be a huge $ cost component for the senior. Some seniors are in and out of the doughnut whole within a few months. How can a true professional make such broad statements that if:... "I were selling MA plans I would not have written any MAPD plans. I personally do not think it would be in the client's best interest."? Look, we all luv ya, but, your simply wrong on this one!

Maybe we could meet at Gladstone's and sit down and have a Red Stripe beer! I'll invite Obama -- he's a Bud Man!

Can you give me one instance where an MAPD would be better for the client than a stand alone MA and a stand alone PDP? If you are doing all this expert service, you should be able to come up with one instance.

It would seem that the one not doing due diligence is the agent that's slamming people into MAPD plans under the guise of doing the right thing.