Humana ACA Commissions/New Rates

[houcoogster]

If the plan you are on now is no longer offered (aca/non-aca)that should trigger an sep. Now if the company wants to auto enroll them they can but why cant a person go ahead and order a new plan, new co. they want and set the effective date to start when the other coverage ends. If they go through an agent we should be able to check a box for sep and write the new plan no gap in coverage.

When the person enrolls in the new plan cms will be notified and so will BOTH (new and old) carriers...I highly doubt the old carrier will try and trump that with an auto enrollment on that person...due to the fact cms was notified in advance.

 

[Ann H]

When the person enrolls in the new plan cms will be notified and so will BOTH (new and old) carriers...I highly doubt the old carrier will try and trump that with an auto enrollment on that person...due to the fact cms was notified in advance.

I've heard nothing about CMS being notified like it is with MAPD. And both carriers are not being notified concurrently like MAPD. In exchange cases, the state's exchange will be notified, and since CCIIO, an arm of CMS must establish the exchanges and then let them administer themselves, then there is a chain of authority, but unlike MAPD, CMS is not notified of carrier changes.

While I'm thinking of this since they enrolled after 12-7 would the coverage start 1-1 or 2-1 because it is an sep if for what ever reason they did get auto enrolled into a plan they did not choose So their first selection during aep starts 1-1 and the sep starts 2-1 I'm just trying to follow the train of thought on this I have no answer on this

Good point about the effective date. I like that and your last line! I don't know either, and I'm just trying to follow the train of thought on this too. I'm one of the few people alive who can say they have never had a headache (true story), but I believe PPACA is about to give me my first one.

 

[taterpeeler]

I've heard nothing about CMS being notified like it is with MAPD. And both carriers are not being notified concurrently like MAPD. In exchange cases, the state's exchange will be notified, and since CCIIO, an arm of CMS must establish the exchanges and then let them administer themselves, then there is a chain of authority, but unlike MAPD, CMS is not notified of carrier changes.



Good point about the effective date. I like that and your last line! I don't know either, and I'm just trying to follow the train of thought on this too. I'm one of the few people alive who can say they have never had a headache (true story), but I believe PPACA is about to give me my first one.

look, answer me this... are we all in agreement that the issue is the verbiage of being automatically enrolled in a ACA compliant plan? That's what started this with me..... then it snowballed

 

[houcoogster]

I've heard nothing about CMS being notified like it is with MAPD. And both carriers are not being notified concurrently like MAPD. In exchange cases, the state's exchange will be notified, and since CCIIO, an arm of CMS must establish the exchanges and then let them administer themselves, then there is a chain of authority, but unlike MAPD, CMS is not notified of carrier changes.

Someone has to approve of the sep's so whoever oversees those should be notified, otherwise sep's don't exist. How can it work any other way? I can see your concern in a state run exchange, I'm glad we're club fed here.

How have you never had a headache? Boggles the mind.

 

[anonymous1]

oo. I'm one of the few people alive who can say they have never had a headache (true story), but I believe PPACA is about to give me my first one.

So jealous. But it's probably because I've dealt with cms since 2007 I started full time jan of 2007 and in march of 2007 cms came up with aep idea. Stopped all ma sales starting april 1 I think. There will definitely be some glitches. My advice is document document document

 

[FLM2]

Am I sorry I started this thread.

I don't know how it morphed into a hypothetical debate over what could possibly happen in December, 2014, all based on a letter sent our in August, 2013, but that is so far in the future how can anyone be concerned when there is absolutely no guidance?

My only input on this, for those of you who haven't written Medicare Advantage plans with an SEP, while the rules are clear they get sidestepped on a regular basis for people that want to change plans (an example would be applying for the LIS and changing plans even though a beneficiary doesn't qualify)-I'd be really surprised if anyone transitioning from a pre-ACA plan to an ACA compliant plan gets left without coverage for a year because of the things mentioned on this thread.

Just my 2 cents...

 

[taterpeeler]

Am I sorry I started this thread.

I don't know how it morphed into a hypothetical debate over what could possibly happen in December, 2014, all based on a letter sent our in August, 2013, but that is so far in the future how can anyone be concerned when there is absolutely no guidance?

My only input on this, for those of you who haven't written Medicare Advantage plans with an SEP, while the rules are clear they get sidestepped on a regular basis for people that want to change plans (an example would be applying for the LIS and changing plans even though a beneficiary doesn't qualify)-I'd be really surprised if anyone transitioning from a pre-ACA plan to an ACA compliant plan gets left without coverage for a year because of the things mentioned on this thread.

Just my 2 cents...

explain more about the lis and not qualifying.....

 

[houcoogster]

explain more about the lis and not qualifying.....

Ahhh those pretty shades of grey...

 

[FLM2]

explain more about the lis and not qualifying.....

I haven't done this myself bcause I don't work that market but I've been told by my FMO that agents who work the lower income markets will submit an application for a LIS and that allows a change in enrollment under a SEP whether or not the LIS is approved.

I doubt that CMS has the resources to verify every SEP claim and the insurance company certainly doesn't care, they want a new subscriber.

At the end of the day I really doubt anyone will get left behind because of an issue with the things mentioned in this thread-it's also way more than a year away, I'm just concerning myself now with the Open Enrollment period this year, the amount of compensation, and the effort needed to make it successful-that was the whole purpose of starting this thread.

 

[taterpeeler]

2 things... I have never had someone not LIS or Dual or Chronic get an SEP related to such SEP..

Next, here is what my Cigna reps just sent and told me:

If a customer elects to keep their current plan instead of changing to an ACA compliant plan on 1/1/14, they can keep this with coverage through 12/31/14.
During the 2015 enrollment season (October-December of 2014) they must select a new plan. They are not automatically changed to anything. Cigna will offer them a 2015 plan as an opt-in, but they could elect to take another carriers product instead if they choose.
There would be no need to participate in a special enrollment period.
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