Humana Non-Renewing PFFS Plans- SEP?

[Lee Sanford]

Has anyone heard what will happen to those currently enrolled in a Humana PFFS which Humana has elected to not renew? In 2009, the most common Gold Choice PFFS plan contract number began with "H1804". There were hundreds of sub-designations (H1804-010, H1804-292, etc.). For 2010, there are 2 (H1804-290 and H1804-128, available in CA, MS, and WA). Do enrollees who no longer have access to their current H1804 plan not get a SEP, just as those who are enrolled in Coventry PFFS do? Or did Humana retain H1804 in a couple of locations to prevent this? Humana has introduced new PFFS plans in most (but far from all) areas under a new contract number (H2994). Will H1804 enrollees be automatically moved to a H2994 plan, where available? If you have enrolless in H1804 plans, you'd better hope not. The new plans are not very good, based on the ones I've looked at. Disenrollment city. Certainly, those enrolled in H1804 plans, but who live in a county in which no PFFS is available for 2010 would receive the SEP, correct?

That's a lot of questions...I truly wonder why there has been zero conversation about this. There are still a huge number of Humana PFFS enrollees out there. In fact, as of 9/1/09, there are 564,514.

Lee

 

[Cenla Agent]

In the past they have automatically moved them to another plan and notified them via the Annual Notice of Change.

In Louisiana and Mississippi I saw this happen in 2007 when they went from 3 Regional PPO plans to one. Two were MAPD and one was MA only. (IIRC the only differences in the plans was the PDP component.) With the MAPD plan, plan members were simply transferred to the remaining plan. I can't remember what happened with the MA-only folks.

Unless some new CMS rule prevents it, my best guess is that they will transfer them to one of the other PFFS MAPD's and will not get a SEP. My understanding is that with Coventry, Wellcare PFFS and others, they have pulled out of PFFS entirely, leaving the member with no other option than to choose another plan or revert back to Original Medicare.

As I understand it, the only time the SEP comes into play is if they want to have the new plan become effective prior to January 1 or perhaps if the application is taken prior to 11/15.
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Also note that in some areas Humana's PFFS has gone up but the Regional PPO has improved and possibly HMO as well, if available. (I'm just looking at premium and MOOP right now, and will have to look at the summary later, it may be that there are big holes in the plans.) In some areas Humana's RPPO network will be quite good.
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Those who move Humana PFFS members to something else will need to remember that, unlike many competitors plans, the Humana PFFS plans are MAPD. If the member is enrolled in a Supp or MA only PFFS, they will need to enroll in a standalone PDP by 12/31 lest they lose their coverage and incur a late enrollment penalty.

I've seen this happen in the past, with the member just assuming that the new plan will cover drugs as well and the agent assuming God knows what, probably hearing Humana and thinking they had Humana's PDP or simply forgetting to enroll them in the standalone Part D.

 

[captain94]

In my area Humana PPO is $6,000 MOOP in-network and $7,800 MOOP out of network. with 30% co-insurance if out of network for outpatient treatment.

 

[Cenla Agent]

In my area Humana PPO is $6,000 MOOP in-network and $7,800 MOOP out of network. with 30% co-insurance if out of network for outpatient treatment.

I am definitely going to look at this. With these high MOOP numbers, it sounds like some of their members may want to take a look at a Medigap provided they can qualify. I will take a closer look at the plans later today, hopefully. In the past compared to other plans it was very unlikely with many of Humana's plans that a member would approach the MOOP unless they made the hospital their new home but that may have changed.

I think the PPO has always been 30% for out of network and/or has had a deductible that had to be met before out of network copays for hospital admissions and doctor visits become applicable. In the areas that I marketed the plans, the network was big enough to where a lot of members wouldn't need to use out of network providers. The main issue would usually be if the hospital(s) was contracted.

 

[Lee Sanford]

There's still they question of what will actually happen to those affected. I know there was a company a couple years back that canceled 2 out of the 4 PFFS plans they offered in a certain area, and those who were on the cancelled plans were not automatically moved and received a SEP. The change from some of these H1804 plans to the new H2994 plans would be VERY VERY dramatic. I truly cannot see CMS permitting such a move. So, back to square one. Wait and see?

 

[Cenla Agent]

There's still they question of what will actually happen to those affected. I know there was a company a couple years back that canceled 2 out of the 4 PFFS plans they offered in a certain area, and those who were on the cancelled plans were not automatically moved and received a SEP. The change from some of these H1804 plans to the new H2994 plans would be VERY VERY dramatic. I truly cannot see CMS permitting such a move. So, back to square one. Wait and see?

You may be right if it is that dramatic a change. The scenario I noted was one in which the plans arguably improved, although in some cases there was a higher premium.

Are you contracted with Humana or just looking to possibly replace some of their MA plans? If you are contracted, why not call Agent Support? They've always been helpful at providing accurate information the handful of times I've had to call them.

Worst case, wait and see. Either they will get the ANOC or an SEP.

 

[Lee Sanford]

I'm an appointed Agent and our Company is an MGA. I've talked to Agent Support a few times and gotten different answers. I've also talked to CMS and gotten varying answers. My hope was that someone might have more reliable information. I don't want to unnecessarily sound the alarm bell, but, if the members will not be automatically moved to a new plan, and the Agent of Record doesn't enroll the client (perhaps due to a lack of being informed in a timely manner) into a new plan, home office will and the AOR will be toast. Just trying to find out for sure.

Thanks!

 

[Cenla Agent]

I'm an appointed Agent and our Company is an MGA. I've talked to Agent Support a few times and gotten different answers. I've also talked to CMS and gotten varying answers. My hope was that someone might have more reliable information. I don't want to unnecessarily sound the alarm bell, but, if the members will not be automatically moved to a new plan, and the Agent of Record doesn't enroll the client (perhaps due to a lack of being informed in a timely manner) into a new plan, home office will and the AOR will be toast. Just trying to find out for sure.

Thanks!

They will have to do something. My understanding is that all Humana PFFS plans are MAPD. If these are MAPD plans, the members will either have to be enrolled into another MAPD or will have to enroll in a standalone PDP by 12/31 in order to keep Part D coverage.

Being familiar with them (and at least some other MA companies operate the same way) I can understand foreseeing how the AOR could be toast. They don't hesitate to get between captive agents and their clients (esp. calling Part D clients and sending other agents who are not the AOR to sell them MA) so brokers are at even more of a disadvantage.

I would just try to stay in contact with your clients and try to find out if they get the SEP or ANOC and then you'll know for sure what you need to do. Advise them that if they haven't gotten it already, within the next few weeks they will be receiving important information from Humana regarding their coverage for the next year and not to throw away anything they receive from them. I doubt the home office will contact them before that time. If they aren't going to be automatically moved to another plan, you can't enroll them before 11/15 and neither can the home office. If they see themselves as primarily your client then you should be ok in most cases. If they see themselves as primarily Humana's client, (and that's easy considering all the mail they get from the company and how easy it is to lose or misplace your card) that's when the AOR can end up being toast. I've been there a few times. The worst is when another agent enrolls them into a different plan and they call you asking for help when they can't get reach the other agent. That happened to me at least once.

Humana is also having the conference calls for delegated agents (brokers.) I think the next one is this Fri. You might try to ask the question there. With the people on those calls, that's as definitive an answer as you'll ever get, assuming of course that someone would know the answer.

 

[Lee Sanford]

Indeed. Very solid advice. Thanks for your input.
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Indeed. Very solid advice. Thanks for your input.