Like to Like - OEP

[GreenSky]

I'm gonna venture to step out and disagree with Rick again.....

I think you would clear up some confusion if you realize the intent of the rules for OEP. You cannot pick up or drop a Prescription Drug Plan during this time. Now, think about what you are doing. If you have a client with a MAPD, and you want to put him in a MA and stand-alone PDP, he will be dis-enrolled from the MAPD in order to enroll in the new PDP. This is not allowed! You are not only dropping one PDP (included in the MAPD), but you are then attempting to pick up a new PDP (doubly wrong!!).

Hope this helps.

Actually, I believe you are wrong. You can drop and MAPD and enroll in an MA plus stand-along PDP. I did this last year during OEP and see no change for this year.

What you can't do is change a PDP to another PDP, or enroll in a PDP if you missed an earlier opportunity.

Last year a client was in an MAPD with Secure Horizons (HMO). I moved him into a PFFS and a stand along PDP. No problem.

Rick

 

[sman]

I'm gonna venture to step out and disagree with Rick again.....

I think you would clear up some confusion if you realize the intent of the rules for OEP. You cannot pick up or drop a Prescription Drug Plan during this time. Now, think about what you are doing. If you have a client with a MAPD, and you want to put him in a MA and stand-alone PDP, he will be dis-enrolled from the MAPD in order to enroll in the new PDP. This is not allowed! You are not only dropping one PDP (included in the MAPD), but you are then attempting to pick up a new PDP (doubly wrong!!).

Hope this helps.

As I stated earlier, I did this very thing during the OEP in 2007. The rules may be different for 2008, but for 2007 it was possible. I tried to attach a copy of the guidelines from Today's Options, but kept getting an upload error message. Instead, here's a link you can see for yourself.

http://image.exacttarget.com/members/22799/OEP Chart.pdf

As you can see, it clearly states that it is allowable (3rd box down under currently have, 4th box over under changing to). So disagree if you'd like, but it doesn't change the fact that it was allowable in 2007. As for 2008, who knows.

 

[GreenSky]

As for 2008, who knows.

Well, actualy, I know. And it's allowable.

In fact, you can even drop your MAPD and go back to medicare with a new PDP. What you cannot do is drop or add a PD plan. In other words, you can do almost anything you want as long as the PD portion continues to exist somewhere.

And you can do this only once.

Rick

 

[honestagent]

Sman, if this worked for you that is great. I am very happy to hear that. I heard that Pyramid's grid was wrong earlier in the year but like I said, if that was good for you.. okay great! Really glad to hear it worked out for you!

Retread... I read and re-ready what you said. Thank you. I am only concerned with MAPD to MAPD (different falvor) not adding or subtracting but only type of MAPD.

Rick, last but certainly not least, thanks for all your input. Do you have a viable source. Also, yes, I was wondering if they want to back to original Medicare, then they can add on a PDP stand alone during OEP and you are saying yes.

One of my fmos told me in an email as the OEP nears, she will send different ruling. She just told me that yesterday in an email so maybe the rules will be different for 08 - hence my querry.

Thank you all for you comments.

 

[Cenla Agent]

I have read in several places that if you join a standalone drug plan while you are in an MA that you will automatically be dis-enrolled from the MA plan. Scratching my head trying to figure out how that works with the information from the carriers.

Winter

That is correct. It is because you can only be in one drug plan at a time.

I've also seen clients lose their drug coverage during the AEP because they were switched from MAPD to MA only, which causes them to lose Part D unless they are also enrolled in a standalone PDP. If they are in this condition for a certain period of time (either 30 or 60 days, but I can't remember) they will be assessed the late enrollment penalty.

 

[Cenla Agent]

Well, actualy, I know. And it's allowable.

In fact, you can even drop your MAPD and go back to medicare with a new PDP. What you cannot do is drop or add a PD plan. In other words, you can do almost anything you want as long as the PD portion continues to exist somewhere.

And you can do this only once.

Rick

This is correct.

If what those who say otherwise are correct, then how can someone go from Original Medicare with PDP to MAPD during the OEP since that is not "like to like"?