First 12 months going to supp. Question?

[jdeasy]

Not new to insurance or senior market. Been in senior market for 15 years. My dad been it for 35+ years.

The old plan will not take these people back. It is an HMO and Medicare told them everyone in it would have to get out of it in 2009. So they came up with a HMO MA and HMO MAPD. Since, Medicare has now changed and said they can keep the old HMO for one more year. The HMO is described as a "cost" plan. From what I have been told, there are only a handfull of these in the entire country. And Medicare is saying they are going to do away with all of these type of plans.

As far as the HMO MAPD people. Perscription Pathway after 4 different phone calls to them say they will not take these people if they were to go back to medicare and a supp. We feel that that is wrong but they are standing firm on their stance. Humana however will take them under SEP.

You need to take this up with CMS. The old plan has to take them back. They also can sign up with any PDP plan. Sometimes you have to get CMS involved to educaate the company marmamdons. Depending on what State you are in, the people could have even more protections that described here.

Anyway, you are taking what the plan says as the final answer. The plan is not the final arbiter. CMS is. I am a certified trainer for the MA and Part D plans. Yet, I still have to get CMS involved in some of the SEP situations because the companies do not know the rules. I recently had a situation with Wellcare where I had to go through 3 levels of management and 3 way call with that 3rd manager and CMS in order to get a simple SEP handled for a couple that were losing credible coverage. No matter how many time I told Wellcare and showed them the rules in writing, they wouldn't budge off their ignorance until CMS told them that I was right. The SEP was granted immediately and they even overnighted the membership card to the folks.

You seem to be at that checkmate. You can drop the issue and wait until AEP or you can get involved in the fight. This is where agents earn their stripes.