Doughnut Hole

[insurance0707]

Well, I just got off the phone with a PDP company and asked them if the PDP plan would give them the full $2510 prescription benefits if they took out a PDP plan with a 4-1-07 effective date or if it would be reduced by what they had already used from Jan - through March. Here's the response....

Me: I have a client that I'm trying to help avoid the doughnut hole in 2008. He has a MAPD plan and I was wondering if we switched him over to your companies PDP plan and a Medicare supplement with a 4-1-07 effective date if he would have the full $2,510 in benefits.

Operator: That's a Medicare supplement question, I'll transfer you to Medicare supplement.

Me: No, this is a PDP plan question.

Operator: I'll put you on hold and check.

Opterator: Ok, No he can't switch at that time, he would have to do it now.

Me: Yes he could, it's the OEP and he can change from a like plan to a like plan

Operator: That is not a like plan to a like plan

Me: Please look at your chart, it will show you that it is

Operator: OK, you're right he can switch. Yes, he will have the full $2,510 in benefits because it's a new policy


????? This is what I was afraid of. I don't think they know the answer for sure. I guess I could call Medicare also. I'll give that a try and let you guys know.

 

[insurance0707]

I called Medicare, I had the same problem they didn't seem to understand what I was asking. Then the operator just said, no that his new plan wouldn't give him the full benefits. they didn't say, wait, I'll check on that or anything, just no.

Oh well, I tried. I don't know if the answer is yes or no. I guess I'm a little more inclined to believe medicare even though I don't think they followed what I was asking and never looked up anything. I guess I'll take it as a "NO" to this subject.

 

[dandan]

During the OEP you can not drop or enroll in a PDP plan period, this should help answer your question.

 

[GreenSky]

During the OEP you can not drop or enroll in a PDP plan period, this should help answer your question.

That wasn't the question.

If he has an MAPD as of Jan. 1, then he can switch back to Original Medicare and take a new PDP effective 4/1/08.

The question is really will the amount of drugs used under the MAPD plan reduce the amount available under the PDP. In other words, is the $2,510 limit appliciable as a total spent under both plans or does it start over with the new plan.

My answer is that it's a ANNUAL limit, irrespective of the number of plans involved. How they keep the record is the only thing I don't know.

In fact, someone could theoretically have a new plan every month. Take out an MAPD plan and move to a new state every month. Enroll in a new MAPD when you move. Would the limit to the donut hole start over each month? I say no but have the same record keeping question.

Rick

 

[craig_ritter]

While you can switch from an MA-PD to original medicare and a PDP during OEP, you cannot "reset" your initial coverage amount. You can't switch from one PDP to another PDP (there is not OEP for PDP only), but MAPD to PDP+Original Medicare is "like for like".

(See the Medicare Rap for more details )

Medicare Acronym Rap â€" Fo’ Shizzle!

Like Rick, I have no idea of how they track this (CMS must have records for each individual Medicare Beneficiary's spending since they "re-insure" the carriers for the catestrophic coverage).

Essentially, this is calendar year versus plan specific.

 

[dandan]

You can change MA to Med supp during OEP but you cannot change from a mapd to a supp and stand alone D plan.

That is how you can keep up with it, its not allowed.

 

[dandan]

ok just kidding.

 

[GreenSky]

You can change MA to Med supp during OEP but you cannot change from a mapd to a supp and stand alone D plan.

That is how you can keep up with it, its not allowed.

You are 100% wrong! Look at the rules.

Rick

 

[retread]

Please allow me to interject my 2 cents: MA plans are administering benefits for Medicare under contract. That's why all paperwork is sent to CMS for final approval. At this point, (if I am correct), the data is entered into the computer system for CMS. Once this is done, all benefit payouts are tracked. That's why switching to another plan won't help. A PDP is a PDP is a PDP, regardless whose name is on it.

 

[GreenSky]

Please allow me to interject my 2 cents: MA plans are administering benefits for Medicare under contract. That's why all paperwork is sent to CMS for final approval. At this point, (if I am correct), the data is entered into the computer system for CMS. Once this is done, all benefit payouts are tracked. That's why switching to another plan won't help. A PDP is a PDP is a PDP, regardless whose name is on it.

That was worth 3 cents! You are correct.

Rick