MA/Med Sup Transplant Questions

[jdeasy]

From Medicare Managed Care Manual Chapter 2:

Non-renewals - A SEP exists for members of MA plans that will be affected by plan or contract non-renewals that are effective January 1 of the contract year (42 CFR §422.506). For this type of non-renewal, MA organizations are required to give notice to affected members at least 90 calendar days prior to the date of nonrenewal (42 CFR §422.506(a)(2)(ii)). To help coordinate with the notification time frames, the SEP begins October 1 and ends on January 31 of the following year.
During this SEP, a beneficiary may choose an effective date of November 1, December 1, January 1, or February 1; however, the effective date may not be earlier than the date the new MA organization receives the enrollment request.
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Overview Medicare Managed Care Eligibility and Enrollment

Thanks! That is very helpful. I didn't read in there where they can get out of their MA plan early. If they can't drop the MA plan until Dec. 31, it wouldn't do any good to sign up for the med sup early. They did mention going to a new MA plan early, but, not going to original medicare early. Unless I missed it, which is entirely possible.

 

[ronmelton3]

Did he leave a supplement to go to a MA plan last year? He may still be in that honeymoon period.

SEP for Individuals Who Dropped a Medigap Policy When They Enrolled For the First Time in an MA Plan, and Who Are Still in a "Trial Period" - For Medicare beneficiaries who dropped a Medigap policy when they enrolled for the first time in an MA plan, §1882(s)(3)(B)(v) of the Act provides a guaranteed right to purchase another Medigap policy if they disenroll from the MA plan while they are still in a "trial period." In most cases, a trial period lasts for 12 months after a person enrolls in an MA plan for the first time. Such individuals would not be eligible for the special election period provided for in the last sentence of §1851(e) of the Act, because they did not enroll in an MA plan immediately upon becoming Medicare eligible, but instead had been in the Original Medicare Plan for some period of time. The right to "guaranteed issue" of a Medigap policy under §1882(s)(3)(B)(v) of the Act would be meaningless if individuals covered by this provision could not disenroll from the MA plan while they were still in a trial period.
Accordingly, there is an SEP for individuals who are eligible for "guaranteed issue" of a Medigap policy under §1882(s)(3)(B)(v) of the Act upon disenrollment from the MA plan in which they are enrolled. This SEP allows a qualified individual to make a one-time election to disenroll from their first MA plan to join the Original Medicare Plan at any time of the year. The effective date would be dependent upon the situation.

 

[jdeasy]

Did he leave a supplement to go to a MA plan last year? He may still be in that honeymoon period.

SEP for Individuals Who Dropped a Medigap Policy When They Enrolled For the First Time in an MA Plan, and Who Are Still in a "Trial Period" - For Medicare beneficiaries who dropped a Medigap policy when they enrolled for the first time in an MA plan, §1882(s)(3)(B)(v) of the Act provides a guaranteed right to purchase another Medigap policy if they disenroll from the MA plan while they are still in a "trial period." In most cases, a trial period lasts for 12 months after a person enrolls in an MA plan for the first time. Such individuals would not be eligible for the special election period provided for in the last sentence of §1851(e) of the Act, because they did not enroll in an MA plan immediately upon becoming Medicare eligible, but instead had been in the Original Medicare Plan for some period of time. The right to "guaranteed issue" of a Medigap policy under §1882(s)(3)(B)(v) of the Act would be meaningless if individuals covered by this provision could not disenroll from the MA plan while they were still in a trial period.
Accordingly, there is an SEP for individuals who are eligible for "guaranteed issue" of a Medigap policy under §1882(s)(3)(B)(v) of the Act upon disenrollment from the MA plan in which they are enrolled. This SEP allows a qualified individual to make a one-time election to disenroll from their first MA plan to join the Original Medicare Plan at any time of the year. The effective date would be dependent upon the situation.

No, this is his 3rd year in an MA plan. There is no dispute that he has the right to go to a med sup since the plan is ending as of Dec. 31. Now we are discussing the when.

 

[Lee Sanford]

Unless I'm way off, disenrolling from MA in order to return to Original Medicare is always an option with an SEP. With an MAPD, one simply enrolls in PDP. With an MA-Only, a disenrollment request needs to be processed by the current plan. I feel confident that CMS, particularly in the event that a plan is not renewing, would want the beneficiary to have that option. You might want to confirm with a specialist at CMS, but they often give the wrong answers. I would suggest using the SEP in very early October to give the plan(s) involved time to process. You can write the Supplement on November 1 with app date as effective date, after you have seen that the beneficiary is switched back to Original Medicare.