Like to Like - OEP

[honestagent]

Another agent and I were batting over what 'like to like' meant for OEP. We both have had different training (if you'd call it that from our noble heirachys) so I'm hoping some insight from you experts can clear things up for us.

Like to Like: In this case let's use a classic MA-PDP.

Does it have to be MA-PDP to MA-PDP? Answer: YES.

Okay, now does it have to be same type of MA-PDP to MA-PDP?

For example:

MA-PDP (PFFS) to MA-PDP (PFFS) Answer: Yes.

Okay but how about MA-PDP (PFFS) to MA-PDP (PPO)?

Is the above stated example a correct 'switch' of a like to like during OEP?

In a generic statement, it's a Med Adv. Plan with the RX going to another Med. Adv. Plan with Rx but the type of programs are different.

What's your input? How were you trained on this topic? And know for certain with no doubt? I'm starting to get a little confused here....

 

[GreenSky]

Another agent and I were batting over what 'like to like' meant for OEP. We both have had different training (if you'd call it that from our noble heirachys) so I'm hoping some insight from you experts can clear things up for us.

Like to Like: In this case let's use a classic MA-PDP.

Does it have to be MA-PDP to MA-PDP? Answer: YES.

Okay, now does it have to be same type of MA-PDP to MA-PDP?

For example:

MA-PDP (PFFS) to MA-PDP (PFFS) Answer: Yes.

Okay but how about MA-PDP (PFFS) to MA-PDP (PPO)?

Is the above stated example a correct 'switch' of a like to like during OEP?

In a generic statement, it's a Med Adv. Plan with the RX going to another Med. Adv. Plan with Rx but the type of programs are different.

What's your input? How were you trained on this topic? And know for certain with no doubt? I'm starting to get a little confused here....

You can go from any "flavor" MAPD to another. You cannot change a PDP plan.

So you are correct. HMO to PFFS, PPO to HMO, etc. as long as they are MAPD to MAPD or MA to MA.

Rick

 

[retread]

I stand with Rick. All companies that I have received training from have the same interpretation of CMS regulations, which seems to be rather straight forward to me. I don't know who this person has received his training, but they do not seem to have the ability to read regulations properly. Always be cautious about getting your regulatory interpretations from other agents. There are even some opinions on this forum that are not in regulatory compliance. I would not jeopardize my license by seeking guidance from here, but from CMS and your carrier.

 

[honestagent]

I stand with Rick. All companies that I have received training from have the same interpretation of CMS regulations, which seems to be rather straight forward to me. I don't know who this person has received his training, but they do not seem to have the ability to read regulations properly. Always be cautious about getting your regulatory interpretations from other agents. There are even some opinions on this forum that are not in regulatory compliance. I would not jeopardize my license by seeking guidance from here, but from CMS and your carrier.

Can we see this in writing folks from CMS' hand and not the carriers? Apparently, everyone has a different spin on this and a black and white answer would sure put me at ease. I've heard and seen different variations from the cert tests .... Have searched the web-site and found nothing. Nothing either in the Med and you 07 book either. Does anyone have something from the Gods of CMS to illustrate blantly in black and white?

 

[midwestbroker]

In OEP you can do the following:

MAPD to MAPD (regardless of PFFS, PPO or HMO)

PDP to MAPD

You can leave your MAPD and go back to orig Medicare and get a PDP plan (this is done by a SEP with the PArt D plan)

If you do not have a Part D plan you can choose a MA plan (with no drug coverage)

You cannot get a MAPD if you do not have a Part D plan in place.

You cannot add or loose your Part D coverage in OEP.

Hope this helps...

 

[Kimber]

Today's Options says you can go from pffs with pdp combo to:
med supp and stand alone pdp,
any other pffs with pdp combo or
HMO/PPO with pdp combo

 

[Cenla Agent]

In a nutshell, the OEP allows the member to make one change to their health coverage. This would include PDP only to MAPD or stand alone PDP and MA, MAPD to standalone PDP + MA, MAPD to PDP and Original Medicare and any other variation.

The main limitation is that they cannot switch their PDP coverage unless it's part of a move to a MAPD or away from one.

 

[senior-advisor-indiana]

YOu cannot switch from a MAPD to a MA with stand alone PDP, During the OEP. YOu can only swtich LIKE to LIKE. MAPD is not like MA and stand alone.

 

[GreenSky]

YOu cannot switch from a MAPD to a MA with stand alone PDP, During the OEP. YOu can only swtich LIKE to LIKE. MAPD is not like MA and stand alone.

I've done some research (okay, talking with carriers) and find that you can go from MAPD to MA and PDP. I always thought this was wrong but it appears it can be done.

But I wouldn't stake my life on that answer.

Rick

 

[honestagent]

While I appreciate some of your feedback, the course of the topic has diverted and yes, we cannot touch pdp unless it's woven into the plan. can we go back to the original question please.. because apparently, I'm hearing yes and no on the 'pick your flavor,' which btw, that is a pretty cool phrase.

So, nowhere in the Med book 08 does it say specifics. Fmos say different. Apparently, we say different too and the carriers all I have a different connonation of it.

An agent last year told me: we'll try on 2 clients 2 ways and see what happens.. gee.. what a crap way to have to find out. I would never do, just saying, and yes this agent was serious.

Forget calling Medicare - that would be like asking a senior the rules.. lol oh my gosh...

can anybody find anything in writing from Med.gov... I have not had such luck. tx p.s. if i find out the answer - the true answer - I'll post it. Till then... I'll be checking back here and there hoping to see something.... ??? !!!!