Election Period To Use

[Jimmy D]

I have a client who has Medicare Part A effective 4/1/06 and Part B Effective 4/1/09. There is no loss of drug coverage as he lost it in December. Can I enroll him in a MA and under what code?

Being that it is already April, I know he can't use the SEP-Delay Part B code because that should have been done in 3 months before Part B's effective date for a 4/1/09 effective as it has to be the same as Part B's effective date.

I don't think I can use an ICEP code because to use it "Medicare part A and Part B are within 3 months of each other". And this is not true. (I know in a past thread someone said to use this, but I've used this code in the past and the application was turned down, so I know personally it don't work, unless rules changed this year)

So is there anything I can do? SEP-GEP Part B?

Or do I just tell him to wait till Nov 15th?

FYI I'm in Hawaii, and MA plans have killer benefits that Med Supplements don't give, so don't give me that answer.

 

[Cenla Agent]

I haven't dealt with this in a while, but if you put him on an MA I think its ICEP since this is his initial election period for MA since he just got Part B. He wasn't eligible for an MA prior to that. This is his initial coverage period (assuming that he has never had Part B before.)

I think maybe you have the 3 month ICEP period mixed up with the period of time between him enrolling in Parts A and B. The fact that he went 3 years between being entitled to Part A and enrolling in Part B (I'm assuming due to loss of group coverage) is immaterial.

When you say he lost his drug coverage in Dec., do you mean group coverage or did he drop Part D?
- - - - - - - - - - - - - - - - - -
He may be looking at a late enrollment penalty for Part D as well. I'd have to check, but him getting Part B now may give him a SEP for Part D as well, or he could go the MAPD route.

This is confusing, but since he just got Part B, that really has nothing to do with his ICEP for MA.

 

[Jimmy D]

He lost his credible drug/group coverage then.

I don't think I have the 3 month period mixed up as I am looking at the "Election Period Details" right now. ICEP does make sense as it would be unfair to the person to not give them time to make a decision, but not all rules the govenment sets are fair. I am also going on past experience (3 years ago) that the app got denied in the same situation.

Also doesn't help me that the companies don't know as well, I talked to 3 of them, and Medicare. Or actually Medicare just said can't enroll untill AEP, like I think I suspect. Just don't want to do my client an injustice if I could enroll him.

 

[Cenla Agent]

He lost his credible drug/group coverage then.

I don't think I have the 3 month period mixed up as I am looking at the "Election Period Details" right now. ICEP does make sense as it would be unfair to the person to not give them time to make a decision, but not all rules the govenment sets are fair. I am also going on past experience (3 years ago) that the app got denied in the same situation.

Also doesn't help me that the companies don't know as well, I talked to 3 of them, and Medicare. Or actually Medicare just said can't enroll untill AEP, like I think I suspect. Just don't want to do my client an injustice if I could enroll him.

If an app got denied 3 years ago under these circumstances, I'm thinking it was in error unless there was some other factor at play. I would put ICEP if he never had Part B before. He's only now becoming eligible for MA, although he should have picked up Part D when he lost his drug coverage since you only have to have Part A or Part B to be eligible for that.

Due to a number of factors (health related primarily) I didn't write any MA's this past AEP/OEP but I haven't seen anything that would indicate that this rule had changed. This is also a situation that doesn't come up everyday, so it can be a little confusing at times.

 

[Todd King]

The fact of the matter is that he is just now getting his Part B. That tells me it's plain and simple....IECP.

 

[ronmelton3]

This person is new to Medicare Part B. You can write them a MAPD.
You can also write a Med Supp w/ a stand alone drug plan. Give them options.

 

[jdeasy]

I have a client who has Medicare Part A effective 4/1/06 and Part B Effective 4/1/09. There is no loss of drug coverage as he lost it in December. Can I enroll him in a MA and under what code?

Being that it is already April, I know he can't use the SEP-Delay Part B code because that should have been done in 3 months before Part B's effective date for a 4/1/09 effective as it has to be the same as Part B's effective date.

I don't think I can use an ICEP code because to use it "Medicare part A and Part B are within 3 months of each other". And this is not true. (I know in a past thread someone said to use this, but I've used this code in the past and the application was turned down, so I know personally it don't work, unless rules changed this year)

So is there anything I can do? SEP-GEP Part B?

Or do I just tell him to wait till Nov 15th?

FYI I'm in Hawaii, and MA plans have killer benefits that Med Supplements don't give, so don't give me that answer.

If the person was eligible for part B in '06 and didn't take it because of other coverage and is now taking part B because of a loss of that other coverage, it is not ICEP. It is SEP/loss of creditable coverage. He would have 63 days to get a med sup or an MA plan. He may not be able to get a PDP since one doesn't have have part B to get a PDP and the 63 days would have started when he lost the creditable coverage.

If loss of employment by either the member or spouse was the reason for losing coverage, he would have an 8 month window from the end of the employment, not the end of the coverage. See page 24 of the 2009 Medicare and You booklet.