MA SEP Question

[vic120]

Assuming your client isn't in the IEP window, three months before their birthday, the month of their birth month and three months after it for a total of 7 months. (for those that could use a refresher ), then if he enrolls before his 06/01 effective date. You would use the ICEP enrollment. His coverage would start the same day of his Part B effective date.

However, if that's not the case and he plans to enroll after his effective date, then you'll have to use a SEP, which I believe you'll have a hard time doing since he's passed the 63 calendar days. Other than that AEP I believe is the only other choice or a Medigap plan.

I Believe he had 8 months to get part B after Group ended, He got it recently with a 06/01 effective. Had to bring the Part B form from employer to get part B,

So group ended 12/01 Part B begins 06/01

I know it can be done because I know I did get 3 or so in the past with 07/01 with Part B from GE in the past So I know it can be done just not sure I remember which code,

I think it may be (IEP-Delayed Part B) I see in AARP booklet, A choice separate from IEP

However, I don't see that option on Aetna App so Not sure if I just put IEP

 

[vic120]

I don't do MA, so I'm not an expert...but isn't it 3 months before the birth month(unless birthday on the 1st of the month), the birth month and 3 months after the birth month for a total of 7 months.

I think that's the way you meant it, but the way you wrote it might be misinterperated by a newbie.

Correct but does not fit this situation as the Prospect is 67 and lost group in Dec, However his part B begins June 1st

 

[J2727]

I Believe he had 8 months to get part B after Group ended, He got it recently with a 06/01 effective. Had to bring the Part B form from employer to get part B,

So group ended 12/01 Part B begins 06/01

I know it can be done because I know I did get 3 or so in the past with 07/01 with Part B from GE in the past So I know it can be done just not sure I remember which code,

I think it may be (IEP-Delayed Part B) I see in AARP booklet, A choice separate from IEP

However, I don't see that option on Aetna App so Not sure if I just put IEP

For Part B

GEP doesn't apply here because he didn't get Part B during the GEP, which would make Part B eff. date 7/1.

His group coverage ended 12/1 and his Part B eff. date is 6/1.
He had 8 months from 12/1 to 7/31 to get Part B. He got it recently for a 6/1 eff. date.

For MAPD

If he got Part B during the GEP, then that would also allow him to get MAPD during 4/1 - 6/30, also for a 7/1 eff. date. But this doesn't apply.

He has(d) 2 options for MAPD:

1) ICEP (Delayed Part B) - lasts 3 months prior to Part B eff. date. In this case, 3/1 - 5/31. MAPD eff. date would be 6/1 (same as Part B).

"If the beneficiary is adding Part B because due to losing creditable coverage, the ICEP would be the three (3) months prior to the Part B effective date."

See # 2, second point below.

2) SEP (Employer Group Health Plan) - starts the month he loses group coverage and lasts 2 more months after.

He missed this since he waited too long to get Part B. Need Part B first, then MAPD.​

 

[vic120]

For Part B

GEP doesn't apply here because he didn't get Part B during the GEP, which would make Part B eff. date 7/1.

His group coverage ended 12/1 and his Part B eff. date is 6/1.
He had 8 months from 12/1 to 7/31 to get Part B. He got it recently for a 6/1 eff. date.

For MAPD

If he got Part B during the GEP, then that would also allow him to get MAPD during 4/1 - 6/30, also for a 7/1 eff. date. But this doesn't apply.

He has(d) 2 options for MAPD:

1) ICEP (Delayed Part B) - lasts 3 months prior to Part B eff. date. In this case, 3/1 - 5/31. MAPD eff. date would be 6/1 (same as Part B).

"If the beneficiary is adding Part B because due to losing creditable coverage, the ICEP would be the three (3) months prior to the Part B effective date."

See # 2, second point below.

2) SEP (Employer Group Health Plan) - starts the month he loses group coverage and lasts 2 more months after.

He missed this since he waited too long to get Part B. Need Part B first, then MAPD.​

View attachment 5262

This is the Problem On UHC handbook it's clear and I have done this before, However going over the Aetna MA App there is no such option ICEP Delayed Part B and I don't know how to do this with Aetna

On Aetna App there are reasons listed, ICEP Delayed Part B is not there nor anything that seems to fit the bill

 

[J2727]

This is the Problem On UHC handbook it's clear and I have done this before, However going over the Aetna MA App there is no such option ICEP Delayed Part B and I don't know how to do this with Aetna

On Aetna App there are reasons listed, ICEP Delayed Part B is not there nor anything that seems to fit the bill

What options does it give you? I haven't done an Aetna MAPD yet.

 

[vic120]

What options does it give you? I haven't done an Aetna MAPD yet.

It is like with reason and code, for instance, new to medical Turned 65 everything is written like that but no anything that fits Part B delayed except the one with Group cov which has to be within the time frame

Its like Silver Script app not like AARP where you put SEP and reason in yourself

Its a check off the list but each code has a sentence next to it like turned 65 or retired on date or moved on date

 

[LostDollar]

Page 141 of the producer manual talks about the general concept you are talking about, but it looks like one has to have access to the ascend system to get more details relating to specific application forms and I can't get into that.

 

[vic120]

Finally Found out from Aetna, There is no option even though it is a valid SEP

So What I am supposed to do is on the front page I need to check T65 (even though the person is not T65) and then on the back of App , Check IEP and write next it the SEP code

 

[J2727]

Finally Found out from Aetna, There is no option even though it is a valid SEP

So What I am supposed to do is on the front page I need to check T65 (even though the person is not T65) and then on the back of App , Check IEP and write next it the SEP code

This is for a paper app?

What about for their e-app?

 

[vic120]

This is for a paper app?

What about for their e-app?

I was told many times by Aetna Reps that it is for face to face only, I did hear from one rep I can do over the phone, I was told by FMO I could use over the phone but at least 8 managers told me no it cannot

So I am not sure if its more trouble then its worth