Clear Spring

[somarco]

I should know this but my brain hasn't fully recovered from AEP . . .

Clear Spring PDP won't be around next year and one of my clients is just figuring it out . . . in spite of 2 newsletters telling folks they weren't going to play in 2025, and I presume the Sept ANOC said the same thing.

So she just now asked me to find her a new plan . . .

What is the protocol for this? Doesn't CMS assign them to a plan if they haven't picked one by 12/7? Or is there an extension to January or February?

 

[rmhaire]

I should know this but my brain hasn't fully recovered from AEP . . .

Clear Spring PDP won't be around next year and one of my clients is just figuring it out . . . in spite of 2 newsletters telling folks they weren't going to play in 2025, and I presume the Sept ANOC said the same thing.

So she just now asked me to find her a new plan . . .

What is the protocol for this? Doesn't CMS assign them to a plan if they haven't picked one by 12/7? Or is there an extension to January or February?

Not one but two extensions.

The first is the hurricane SEP through 2/28. All counties in GA.

The second is a EOC-SEP for end of coverage. Also through 2/28 and started 12/7. Not good for crosswalks though.

Just got an email from Humana on it today. I'll send it to you.

 

[somarco]

@rmhaire those sound like MAPD, not PDP.

Clear Spring is turning into a pumpkin on 12/31. No crosswalk.

I believe we are talking about 2 different things.



EDIT: After posting this, it pulled up a "regular" (non-AEP) PDP app and looked through the 157 way you may qualify to enroll in a PDP outside of IEP, AEP and all the other 3 letter options, and found one I have never had to use before. Paraphrasing .. . It Medicare kicked the carriers sorry ass to the curb, policyholders you screwed are entitled to enroll in a new plan even though under normal circumstances Medicare's arcane, arbitrary rules would lock them out.

 

[rmhaire]

@rmhaire those sound like MAPD, not PDP.

Clear Spring is turning into a pumpkin on 12/31. No crosswalk.

I believe we are talking about 2 different things.

Nope. Includes PDP to PDP.

 

[Yagents]

What about pdps that were mapped like those who were moved to Aetna Silver Script with a much higher premium? Can they change pdps?

 

[rmhaire]

What about pdps that were mapped like those who were moved to Aetna Silver Script with a much higher premium? Can they change pdps?

Depends on your definition of mapping. Some agents consider mapping and cross walking the same thing when they're not.

Mapping is moving a particular drug from one tier to another within the same plan. Cross walking involves changing the actual plan.

But the EOC SEP would not apply to either one.

The EOC SEP only applies to plan exits or service area reductions.

It applies to MA, MAPD and PDPs and even applies to clients that changed plans during AEP.

 

[Fisher]

I believe we are talking about 2 different things.

You are not.

 

[vic120]

Depends on your definition of mapping. Some agents consider mapping and cross walking the same thing when they're not.

Mapping is moving a particular drug from one tier to another within the same plan. Cross walking involves changing the actual plan.

But the EOC SEP would not apply to either one.

The EOC SEP only applies to plan exits or service area reductions.

It applies to MA, MAPD and PDPs and even applies to clients that changed plans during AEP.

I got an email from a doctor who refers to me from time to time and one of her patient's their plan will no longer be available for 2025

The thing is they only received the letter this week
Also I don't know of any other SS clients getting this letter

Now I know these are being cross walked into the choice plan

The other thing is the Choice plan is a lesser plan then the high option anyway

 

[somarco]

Choice plan is a lesser plan then the high option anyway

Also, no preferred pharmacies.

I have run a few reports comparing the Choice plan to other, lower premium plans, and discovered the copays are often CONSIDERABLY higher than comparable (lower premium) plans

 

[rmhaire]

I got an email from a doctor who refers to me from time to time and one of her patient's their plan will no longer be available for 2025

The thing is they only received the letter this week
Also I don't know of any other SS clients getting this letter

Now I know these are being cross walked into the choice plan

The other thing is the Choice plan is a lesser plan then the high option anyway

After doing some more research on your post here, there may be a way to use the EOC SEP in your client's case.

The carriers say you can't but what do they know.