Issue with CMS not replacing MAPD with new PDP

Dec 2, 2018

  1. WCMason
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    WCMason Guru

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    With individual plans I've heard it's now opt-in rather than opt-out, but I've not heard anything about retiree plans going to opt-in only, and the clients I've worked with who have retiree plans are continuing to be auto-enrolled. The rationale is that many employer plans will not let a retiree back into their plan if they don't take it when first eligible or leave it, with some exceptions. So retirees get auto-enrolled and CMS prevents an individual PDP or MA plan from replacing a retiree MA plan until the retiree first takes separate action to cancel it.
     
    WCMason, Dec 3, 2018
    #11
  2. somarco
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    somarco That Medicare Guy

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    Only time I run into seamless conversion is with teachers on the state plan. It has been a few years since I ran into this. Most teachers won't even consider something not endorsed by their union.

    Last time I recall seeing it was 2 or 3 yrs ago. Conversion automatic unless you opted out.

    Like everyone else they get so much junk mail it is easy to overlook. Next thing they know they have been on Medicare 6 months and just found out few docs in their area participate in the network.
     
    somarco, Dec 3, 2018
    #12
  3. vic120
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    vic120 Guru

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    I've run into this too, Some retiree plans make you jump through hoops

    Had a retiree sing up last year and canceled group retiree cov, and got declined on PDP 2X and the client and I couldn't figure out what the issue was

    Until it came out the group required 2 cancellations one for the health and another for the drug coverage, Except HR does not tell you this until you make a big issue of it
     
    vic120, Dec 4, 2018
    #13
  4. somarco
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    somarco That Medicare Guy

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    I presume this administrative BS is at the carrier level, not HR. Carrier trying to snipe as many fish as possible before they wake up and realize what happened.
     
    somarco, Dec 4, 2018
    #14
  5. LostDollar
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    LostDollar Guru

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    given the characteristics of some of the plans, it might actually be hr.
     
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