Cancer Patient Stuck in Mapd - Can We Get Him Out?

[honestagent]

I have a complex case. What would you advise? Can you help?

I have a good friend who lives in Florida. Her dad ended up with cancer and is in skilled nursing right now waiting to leave the hospital. I'm not clear how much if any cancer is left within him. He is on Humana Gold (they are not sure if it's ppo or pffs – I'm thinking pffs). They want out of the plan. They are paying too much in OOP. They chose the plan a few years ago, before the aftermath, based on the media and when he was healthy.

The questions are:

• Can he elect a PDP during OEP? (he has an mapd with Humana right now). I am getting mixed emails about CMS and I don't trust them to get this right.
• Have any of you had clients come out of an MAPD during OEP and elect a PDP and if so, were they successful in change during OEP this year thus far?
• If successful, what course did they take to elect the change? Did they call Medicare directly or the carrier?
• B/c he is currently in the hospital and has a terminal illness, can he qualify right now for a guarantee issue med sup?
• I know it sounds ridiculous I am asking about a med sup – guarantee issue, but I have not written any GI policies Med.Sup outside of advantage so I don't know and he definitely has a terminal disease couple that with being currently hospital bound.
• Assuming he can get a GI, with whom for lowest premium in FL? I know here in MI. it's BCBS hand down, $107.99 statewide, healthwise, zipcode , age.. it doesn't matter. Everyone is $107.99 and that plan is equal to and F,J, and or K all combined in one! They pay NOTHING for this rich benefit plan, not even the B deductible of $131.00.
• But I'm not acclimated whatsoever with FL, and do not know if BCBS is like this in FL? Or if any other carrier is competitive this way. He is 76 years of age btw and they are in Tampa. I'm not sure what the zip is but I can find out if it warrants more info.

P.S.: They are looking for a plan that is equal to or pretty darn close to BCBS's as I characterized above be it a D, G, F, or J K. I don't think they would gripe about paying a B deductible if everything else was zero.

Thoughts please?

 

[Joe Moore]

Vicky,

He CAN go back to Original Medicare, and a NEW PDP. Here are the rules:

Existing Plan Allowable Switch
MA-PD(HMO, POS, PPO or
PFFS with drug coverage
included in the plan)​

Can switch to another MA-PD (HMO, POS, PPO, PFFS) with drug

coverage included in the plan.
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Can switch to a PFFS Medical only plan and join a PDP. Can switch to Original Medicare and join a PDP.

The problem I see is then getting a Medicare Supplement issued. In Tennessee I think we could get AARP issued in this situation on a GI basis. I am not sure, but think FL also has the same plan available. If you have AARP, check it out. If you don't, give me or Greg a call at the office in a couple of hours and we will check to see if the same is available in FL.

Joe
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Assuming he can get a GI, with whom for lowest premium in FL? I know here in MI. it's BCBS hand down, $107.99 statewide, healthwise, zipcode , age.. it doesn't matter. Everyone is $107.99 and that plan is equal to and F,J, and or K all combined in one! They pay NOTHING for this rich benefit plan, not even the B deductible of $131.00.

I don't think these premiums would even be close to realistic in FL. Right now, I would just check to see if anything is available he could move to, and not be too concerned over the lowest premium.

The "Pre-Existing Condition" clause also needs to be addressed, if you can get a new Medicare Supplement issued. Humana may actually be the best to stay in. You may need to see what the Maximium Out of Pocket is with the present plan (and what is covered by the MOO).

 

[allhealthandlife]

Yes can definetly can switch to original Medicare and PDP. I am an agent in Fl and contracted with AARP Supps and as long as he doesn't have ESRD he will be accepted. I just switched one of my clients on who just started chemo from mapd to plan J on AARP for 2/1/09 no problem.I am in North Florida and will be in the Orlando/Tampa area tomorrow if you want me to write them 904-891-2293 Joe

BTW med Supps in Fl are more expensive but AARP Supps are for most ages in most areas the cheapest standard med supps.Plan J for 76 yr old is 211.75 or 199.75 depending on zip in Tampa area.

 

[honestagent]

Joe, your # you entered is not working. Do you have another #?

Yes can definetly can switch to original Medicare and PDP. I am an agent in Fl and contracted with AARP Supps and as long as he doesn't have ESRD he will be accepted. I just switched one of my clients on who just started chemo from mapd to plan J on AARP for 2/1/09 no problem.I am in North Florida and will be in the Orlando/Tampa area tomorrow if you want me to write them 904-891-2293 Joe

BTW med Supps in Fl are more expensive but AARP Supps are for most ages in most areas the cheapest standard med supps.Plan J for 76 yr old is 211.75 or 199.75 depending on zip in Tampa area.

 

[allhealthandlife]

Joe, your # you entered is not working. Do you have another #?

Sorry about typo phone is 904-891-2283 if I can still help.

 

[Carbonmated]

I may be wrong here, so please correct me if I am wrong. Nov 15th - Dec 31st he could have switched from a MA plan to anything he wanted to, since he is no longer in open enrollment there is no GI. GI would only be available if he were losing credible coverage involuntarily. At this time in the year, he can switch from "like to like" plans. As far as AARP having a GI med supp, I took the liberty of checking one of their actual policies. Pre existing condition limitation will apply if advice or treatment was given within 3 months of effective date, any stay or medical expenses incurred during the first 3 months after effective date will not be considered if due to a pre existing condition.

Pre existing limitations provision will not apply if in open enrollment, just like any other med supp from any company.

 

[GreenSky]

I may be wrong here, so please correct me if I am wrong. Nov 15th - Dec 31st he could have switched from a MA plan to anything he wanted to, since he is no longer in open enrollment there is no GI. GI would only be available if he were losing credible coverage involuntarily. At this time in the year, he can switch from "like to like" plans. As far as AARP having a GI med supp, I took the liberty of checking one of their actual policies. Pre existing condition limitation will apply if advice or treatment was given within 3 months of effective date, any stay or medical expenses incurred during the first 3 months after effective date will not be considered if due to a pre existing condition.

Pre existing limitations provision will not apply if in open enrollment, just like any other med supp from any company.

I don't think they can hit you with pre ex if you are coming from creditable coverage such as an MA plan. Could be wrong but it is correct for CA and I think for other states as well.

Rick