Is this Woman Screwed?

[somarco]

Had Piedmont-Wellstar MA for 2014 and 15. P-W will be discontinued as of 12/31

She contacted me about a month ago for help transitioning to Medicare + Medigap. Diagnosed with cancer about a month earlier, wants to keep her docs and minimize her OOP.

Until this year I have avoided GI business like the plague but have written maybe half a dozen this year and will probably live to regret most of them. This one in particular.

Among other things I requested was her termination letter from P-W. At first she said she didn't get one then a week later she said she found it.

Didn't submit the app until she came up with everything.

I glanced through the letter, and found some of the wording odd, but was at the tail end of AEP and trying to wrap up everything.

Now the carrier is refusing the letter due to wording that says "Medicare has confirmed your disenrollment ................"

They say SHE disenrolled voluntarily which I admit certainly seems to be backed up by the phrase above.

The letter from P-W is dated 11/5/15 which post-dates the notice from P-W to their policyholders announcing the discontinuance from the plan.

The woman did mention working with someone else before she contacted me but said she was not happy with the advice she was getting.

I wonder if she was enrolled in Part D prior to 11/5 which triggered her disenrollment and killed off her GI rights?

Of course since all this surfaced she is out of the country and won't be back until the end of the year so I can't have any communication with her.

She can't pass underwriting. It seems to me her options (unless the carrier can and will grant her a GI policy) are original Medicare or enroll in another MA plan.

But is it too late to enroll in another MA plan for 2016?

 

[midwestbroker]

Sounds likes she is screwed.

However, I would try and slide an app in under the SAR (service area reduction) clause for her supplement as she would have GI into Plan F or get her into another MAPD plan.

 

[TN_agent]

I had one just like this recently. My lady got a letter October 2nd from her carrier that says we are discontinuing the plan and keep this letter as proof of medigap gi. Another on the 6th from her carrier saying that medicare had approved her request to leave her plan and if she wanted to stay on the plan let them know. Talk about confusing for these people. She had not taken any action at that point. She is lis however so was autoenrolled onto pdp.

The one you want to use is the first letter, not the second. It is the one that proves her gi. Now, if she had already enrolled in an mapd starting in December maybe she is screwed, but I don't know why enrollment in a standalone pdp would kill her gi. Assuming January 1 start date on the pdp. What else are they supposed to do for drug coverage?

Eta: am I wrong here? I am new to this stuff so someone correct me if I am wrong. The app on this lady is still processing so maybe mine is screwed as well? That would mean all lis people are screwed then because they are autoenrolled by medicare into new drug coverage when their mapd leaves an area.

 

[somarco]

Thanks TN agent, but as indicated, she is out of the country until end of the year. She is not a "detail" person and may have lost her initial letter.

When I first saw the letter she sent, I questioned it, but she said that was the only letter she could find.

Don't know if her 11/5 letter is similar to the one your client received or if she did indeed enroll in a drug plan (via the other agent) and not realize the implications.

This is my first, and last year, to fool with GI. Not worth the headache. Didn't have a single app that went smoothly.

 

[midwestbroker]

If she made a change in AEP, the SAR enrollment code will not work. It is only valid from 12/8 - 2/29.

 

[sman]

Thanks TN agent, but as indicated, she is out of the country until end of the year. She is not a "detail" person and may have lost her initial letter.

When I first saw the letter she sent, I questioned it, but she said that was the only letter she could find.

Don't know if her 11/5 letter is similar to the one your client received or if she did indeed enroll in a drug plan (via the other agent) and not realize the implications.

This is my first, and last year, to fool with GI. Not worth the headache. Didn't have a single app that went smoothly.

If you have her personal info (Medicare number, Part A start date, birthday and zip code) you can look up and see if Medicare shows her future coverage as a Part D plan. That would answer the question as to how the plan was terminated.

https://www.medicare.gov/find-a-plan/questions/home.aspx

Use the personalized search section.

 

[somarco]

Thanks Scott.

Future coverage shows Silver Script PDP but does not show application date or if there was a prior PDP which could have generated the 11/5/15 letter.

Important coverage information -

Our records show that you are currently enrolled in Piedmont WellStar Medicare Choice (HMO). This plan provides prescription drug coverage and is a Medicare Advantage (MA) Plan – Health Maintenance Organization (HMO). This Health Maintenance Organization Plan processes claims for your Part A and Part B covered services and any additional services covered by the plan. Our records show that this coverage will be ending and you will be enrolled in SilverScript Choice (PDP) on 01/01/2016. Your new plan also covers prescription drugs. It is a NONE For more information about your new plan, call (866) 235-5660 to speak to a representative.

Our records show that you currently do not receive extra help, which pays for Medicare prescription drug coverage.

 

[kstein]

Maybe letting of that screen and call the mapd to get a stock SAR letter, asking with a copy of her ID card?

 

[sman]

Thanks Scott.

Future coverage shows Silver Script PDP but does not show application date or if there was a prior PDP which could have generated the 11/5/15 letter.

Important coverage information -

The fact that the letter indicates the new plan means the disenrollment was due to the PDP application. She really needs to find the original letter PW sent regarding the termination of the plan.

Due to the wording of the current letter (11/5/15), the Med Supp carrier deems it as a voluntary disenrollment and not a plan termination.

 

[bill3173]

Maybe letting of that screen and call the mapd to get a stock SAR letter, asking with a copy of her ID card?

That is good advice that actually worked for me on a recent case. I just sort of shook my head when they passed it through as GI. The best part was I sent in the ID card, and it was approved before I could get the letter to them.