Client Selected Wrong Coverage.

[StephanieCJ]

Client turns 65 this month and Medicare A & B began November 1. He attended sales seminar for one of my carriers October 8. I strongly encourage people to sit down with me and let me verify doctors & RX before signing up on a plan (copays, tiers, etc.). He wants to sign up immediately after seminar, says he already looked at doctors and RX and everything is covered for him so does not need me to verify. Client calls Nov. 2 to let me know that he recieved his documents and when he was going through them, several of his maintenance meds are tier 4 and he thinks he may have selected the wrong plan for himself. I had a cancelation this coming Monday, so I have worked him in and asked him to bring a list of doctors and medicines with him to my office so that we can cover the cost for him on each. Just curious...If I end up moving him to either another carrier or a supplement, does the ICEP/IEP/Open Enrollment (depending on what route we take) still apply to get him a December 1 effective date since his is still in that window, or has it already been satisfied by the plan selection going into effect? I might be overthinking it, but I appreciate ya’lls input.

 

[russelltw]

He would still be okay with med supp.

I think once you have picked a PDP/MAPD for IEP and it has gone into effect, then they have used it and have to wait for either SEP or AEP.

He can wait for AEP on the Part D (1/1/19 start) and use the initial enrollment (6 months after t65) for med supp.

Looks like he is on that plan until 1/1/19. It might be a costly lesson for him.

 

[JJ2713]

Client turns 65 this month and Medicare A & B began November 1. He attended sales seminar for one of my carriers October 8. I strongly encourage people to sit down with me and let me verify doctors & RX before signing up on a plan (copays, tiers, etc.). He wants to sign up immediately after seminar, says he already looked at doctors and RX and everything is covered for him so does not need me to verify. Client calls Nov. 2 to let me know that he recieved his documents and when he was going through them, several of his maintenance meds are tier 4 and he thinks he may have selected the wrong plan for himself. I had a cancelation this coming Monday, so I have worked him in and asked him to bring a list of doctors and medicines with him to my office so that we can cover the cost for him on each. Just curious...If I end up moving him to either another carrier or a supplement, does the ICEP/IEP/Open Enrollment (depending on what route we take) still apply to get him a December 1 effective date since his is still in that window, or has it already been satisfied by the plan selection going into effect? I might be overthinking it, but I appreciate ya’lls input.

Is this MAPD or PDP?

I don't know if you can cancel a MAPD or PDP once you enroll during initial enrollment. Good question. Would like who knows to answer.

If he can't cancel, just put him on the correct plan before 12-7 (AEP). The correct Plan will take effect 1/1.

So, either you cancel the current wrong plan and put him on the correct one, with initial enrollment intact... or you simply have no choice but to leave the wrong plan and put him on the correct plan this AEP for a 1/1 effective date.

Worse case scenario, he has the wrong plan for 2 months.

 

[sshafran]

Is this MAPD or PDP

She said member “looked up his doctors,” so I’d wager it’s mapd.

 

[sshafran]

He would still be okay with med supp.

I think once you have picked a PDP/MAPD for IEP and it has gone into effect, then they have used it and have to wait for either SEP or AEP.

He can wait for AEP on the Part D (1/1/19 start) and use the initial enrollment (6 months after t65) for med supp.

Looks like he is on that plan until 1/1/19. It might be a costly lesson for him.

He can also use SEP65 for the pdp for 12/1, and med supp of course 12/1.

 

[J.R.]

Client turns 65 this month and Medicare A & B began November 1. He attended sales seminar for one of my carriers October 8. I strongly encourage people to sit down with me and let me verify doctors & RX before signing up on a plan (copays, tiers, etc.). He wants to sign up immediately after seminar, says he already looked at doctors and RX and everything is covered for him so does not need me to verify. Client calls Nov. 2 to let me know that he recieved his documents and when he was going through them, several of his maintenance meds are tier 4 and he thinks he may have selected the wrong plan for himself. I had a cancelation this coming Monday, so I have worked him in and asked him to bring a list of doctors and medicines with him to my office so that we can cover the cost for him on each. Just curious...If I end up moving him to either another carrier or a supplement, does the ICEP/IEP/Open Enrollment (depending on what route we take) still apply to get him a December 1 effective date since his is still in that window, or has it already been satisfied by the plan selection going into effect? I might be overthinking it, but I appreciate ya’lls input.

Please break up your paragraphs. The "prospective" client already used up the ICEP. You still got OEP/AEP and a few other possibilities. I LOVE the fact that you had a cancellation, but could work him in. Unless his/her/it has a ridiculously long list of items to go over, I would STRONGLY encourage you to take 5 minutes to get the FACTS, over the phone, FIRST. Everybody is an expert until things get jacked up. Don't waste their time, or yours.

A 12/1 effective date is still possible for "some" products. Reinforce what YOU bring to the table and take it from there.

Enjoy the song

 

[StephanieCJ]

Thanks for the input despite my grammatical faux pas. Yes it was MAPD. Doesn’t even want to look at supplement because of the cost. He had already done the research and is planning on ordering two of his eye drops from Canada. Even still, ran his meds and placed him with another carrier entirely for a 1/1 effective date (medicines came out way better and all doctors/hospitals in network on both plans).

 

[somarco]

He had already done the research and is planning on ordering two of his eye drops from Canada.

Same guy that did his own research on MA plans?

I am a bit confused.

Did you take the initial app (drive through order actually) or did he apply direct then came back to you to fix the problem?

 

[J.R.]

Thanks for the input despite my grammatical faux pas. Yes it was MAPD. Doesn’t even want to look at supplement because of the cost. He had already done the research and is planning on ordering two of his eye drops from Canada. Even still, ran his meds and placed him with another carrier entirely for a 1/1 effective date (medicines came out way better and all doctors/hospitals in network on both plans).

Glad to hear it. Onward and upward!