Issue with CMS not replacing MAPD with new PDP

Dec 2, 2018

  1. russelltw
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    russelltw Guru

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    Any of you had an issue where a group MAPD is in effect for 1/1/19 (new to Medicare). Client wants to enroll in stand alone PDP with med supp. Supp is in place, but have submitted the SilverScript app twice and it will not replaced the group plan that is supposed to start 1/1/19.

    I get emails from SilverScript saying the app has been cancelled. Check enrollment status on Medicare.gov and it still shows the group MAPD plan. Thoughts?
     
  2. WCMason
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    WCMason Guru

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    While a new PDP enrollment normally replaces the current one, it works the other way around when it's a group MAPD or PDP. The new application is blocked by the current plan. This needs to be resubmitted after the group plan is gone. I've run into this a few times with those leaving the Texas Teacher Retirement System. The reason is that CMS does not want people to lose an employer plan that easily given that many employers don't let them get it back.
     
    WCMason, Dec 2, 2018
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  3. kstein
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    kstein Guru

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    Also make sure you are coding it losing eghp as well
     
    kstein, Dec 2, 2018
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  4. russelltw
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    russelltw Guru

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    She is t65 in January. WCMason, when you say gone, do you mean to have client call in a disenroll?
     
  5. WCMason
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    Yes, she needs to disenroll first as it appears they have auto-enrolled her into the retiree MA plan. How to disenroll depends on the group plan rules. With the TRS plan I mentioned retirees have to request a form sent by the group benefits office and return it with a notarized signature. I expect most retiree plans will need the request to terminate in writing.
     
    WCMason, Dec 2, 2018
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  6. somarco
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    somarco That Medicare Guy

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  7. TwoCents
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    It would have been nice if SilverScript told you exactly why the PDP was rejected (I'm doubting they did.). I'm going to hazard a guess and say this is why -- From CMS enrollment guidance for group MA coverage: For enrollments processed using the SEP EGHP, the application date on the enrollment transaction submitted to CMS is the first day of the month prior to the effective date of the group enrollment.

    So with the group plan starting 1/1/19, CMS will have an application date of 12/1/18. Any application written prior to that will not go into effect. I would think if you wrote the PDP now, it would go through, but it's probably best, like others advised, for the client to opt out of the group coverage then apply for the PDP.
     
  8. WCMason
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    Yes, with one big difference between retirees and individuals who are seamlessly converted. Retirees have to cancel the plan they got converted to before they can enroll in anything else. With an individual seamlessly converted a new PDP or MA will replace the auto-enrolled plan. It's harder for retirees to renounce their forced conversion.
     
    WCMason, Dec 3, 2018
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  9. somarco
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    somarco That Medicare Guy

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    Any idea why?

    The seamless conversion process changed a few years ago after so many complaints. Instead of an "opt -in" form the employer/carrier ASSUMES you want to "continue" coverage unless you sign and "opt-out" form.
     
    somarco, Dec 3, 2018
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  10. TwoCents
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    Oh, this reminds me...seamless conversion (commercial to Medicare at least) doesn't exist for 2019.
     
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