Issue with CMS not replacing MAPD with new PDP

[WCMason]

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.

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.

 

[somarco]

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.

 

[vic120]

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.

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

 

[somarco]

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

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.

 

[LostDollar]

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