Change County of Residence

Sep 1, 2015

  1. openmindedone
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    openmindedone Super Genius

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    I enrolled a lady into a Medicare Advantage Plan recently. CMS turned her down saying it isn't available in her county. She calls Medicare and they have her correct address just not the correct county of residence.

    Medicare says they can't change it and she needs to take it up with SS. SS says when they do a change of address form there isn't even a field for the county of residence.

    I should point out that she lives in a zip code that spans two counties.

    Can anyone please point me in the right direction so I can help get this lady's county of address corrected? Thanks.
     
  2. DS4
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    Have her take a copy of her county tax bill into Social Security.
     
    DS4, Sep 1, 2015
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  3. TwoCents
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    Did CMS turn her down or the carrier?
     
  4. openmindedone
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    openmindedone Super Genius

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    CMS turned her down, based on the plan not being offered in the county they think she resides in.

    She took her tax bill into Social Security and they told her they can't change it. I assumed that was mis-info but I called social security twice and that's what they tell me too.
     
  5. TwoCents
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    Sorry to scrutinize, but how exactly did CMS turn her down? Were you trying to have her enroll by calling 1800Medicare? I would just use their website (the county field is optional, but of course you'd want to use it) and then let the carrier process the app.
     
  6. DS4
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    I would assume the agent submitted the app to the carrier, carrier transmitted to CMS, CMS transmitted back to carrier not eligible?
     
    DS4, Sep 1, 2015
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  7. TwoCents
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    It doesn't quite work that way. Think of all the people who move and don't immediately update their address with SSA. CMS would return an electronic reply to the carrier for them to investigate the address, but they wouldn't have to do this investigation as the address was recently confirmed via the application (see Chapter 2 MA guidelines 50.2.1.3).

    So I would still like to hear how CMS turned down the enrollment.
     
  8. DS4
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    I live in a zip code that spans two counties.
    When you enter this ladies zip, does the "pop up' window appear?
     

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    DS4, Sep 1, 2015
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  9. openmindedone
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    openmindedone Super Genius

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    Yes. If I entered her zipcode on the Medicare website, this window would pop up and have the two counties listed. The county she lives in and the county they think she lives in.

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    I submitted the enrollment to the plan. The plan submitted the enrollment to CMS for approval. CMS said she is not eligible because she lives outside of the service area.

    Of course she does live in the service area, CMS just has her county of residence wrong and I'd like to point her in the right direction to fix it.
     
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