MA Trial Period Question

[Dowejonez]

If a policyholder on the 12 month trial goes back, are they required to be put back on a plan which is no longer being offered?

Specifically it's some of the really old AARP supplements. One in particular i'm working with is an old plan J. Now, the J doesn't pay for drugs anymore but she claims that she gets a rebate check back at the end of the year for about $1500 as she has a decent sized Rx bill.

Of course...she thinks this is magical. I think it's mysterious at best. Haha.

This particular J plan is up to $300/month for age 76. I have another AARP sup which is $154 at age 88. That one I'll probably leave alone unless I was certain she could get it back again. She takes no meds and is healthy.

 

[Winter_123]

If a policyholder on the 12 month trial goes back, are they required to be put back on a plan which is no longer being offered?

Specifically it's some of the really old AARP supplements. One in particular i'm working with is an old plan J. Now, the J doesn't pay for drugs anymore but she claims that she gets a rebate check back at the end of the year for about $1500 as she has a decent sized Rx bill.

Of course...she thinks this is magical. I think it's mysterious at best. Haha.

This particular J plan is up to $300/month for age 76. I have another AARP sup which is $154 at age 88. That one I'll probably leave alone unless I was certain she could get it back again. She takes no meds and is healthy.

I don't follow this. She has a one year right to go back if it is her first time in. So if she came off the old plan J, she has been in the MA for more than a year right ? --so there is not much basis to be talking about which plan she has a right to go back to is there? Where am I going wrong here?

 

[MedSuppPro]

JDEasy and I do this all the time!

But, if her AARP 300 Buck Plan covered Rx's, then you better be real careful!

 

[DS4]

If a policyholder on the 12 month trial goes back, are they required to be put back on a plan which is no longer being offered? .

If that particular Med Supp is closed to new enrollment, then, no, they couldn't go back to that plan. They would be offered A, B, C, F, etc

Specifically it's some of the really old AARP supplements. One in particular i'm working with is an old plan J. Now, the J doesn't pay for drugs anymore but she claims that she gets a rebate check back at the end of the year for about $1500 as she has a decent sized Rx bill.

The old plan J w/Rx prior to 1.01.06 had the follow Rx coverage, $250 Deduct, 50% to $3000 cal yr max. She is probably saving up her Rx receipts and mailing them in at the end of the yr, thus, her so call $1500 rebate check.

With the $3000 cal yr max on Rx, this person, if leaving a MA, should go back to Med Supp D or F and buy a Part D.

Although I didn't sleep at a Holiday Inn last night, I believe the above to be true.

 

[MedSuppPro]

If I re-read the original post it sounds like this lady still has an old AARP plan. And so she could get an MAPD with a donut whole.

I still would be careful with this one. We don't know enough about this case. She probably has no Formulary with QL, ST, and PA's and nor do we know what she is taking now. What would a good supp cost her in your state? And the PDP premium and out-of-pocket would be? Just a few concerns. And what ever happened to YODA?

 

[DS4]

Also, if this prospect does in fact have the "closed" Plan J with embedded Rx coverage, upon changing to a MAPD, or, stand alone PDP, etc, they would pay the Part D late enrollment penalty as "closed" Plan J is not considered creditable coverage.
You need to be sure to do a through fact finding. Specifically, what Med Supp policy is this person on????

Yoda was spotted selling PDP's at WalMart.

 

[jdeasy]

JDEasy and I do this all the time!

But, if her AARP 300 Buck Plan covered Rx's, then you better be real careful!

I do help people get back on a med sup that are in their trial and I do move people to a med sup that are losing their MA plans, but, I don't believe I understand the question here enough to respond as to how to proceed.

 

[Dowejonez]

If that particular Med Supp is closed to new enrollment, then, no, they couldn't go back to that plan. They would be offered A, B, C, F, etc


The old plan J w/Rx prior to 1.01.06 had the follow Rx coverage, $250 Deduct, 50% to $3000 cal yr max. She is probably saving up her Rx receipts and mailing them in at the end of the yr, thus, her so call $1500 rebate check.

With the $3000 cal yr max on Rx, this person, if leaving a MA, should go back to Med Supp D or F and buy a Part D.

Although I didn't sleep at a Holiday Inn last night, I believe the above to be true.

Yes....this is sounding pretty close to what she has. She doesn't really know what she has. I had gone through it a couple of years ago and left it alone when I couldn't figure it out. Her premium wasn't nearly as high then. I had plan J in my notes.

I've had her husband on an MAPD the last couple years and he wanted me to try again. This is what I'm especially afraid of...that she couldn't get the exact same plan back.

Thanks to all....not that I don't want more input.....but this helps alot.
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It never occurred to me that she had the old Plan J with Rx. I thought they had to give up any drug benefit the year they became obsolete. This is actually not a very good deal at all for her. With her really high drug bill she probably is paying quite a bit more than with a PDP. I'll still put a pencil to it first, and figure about $4 per year in penalty.

It's kind of funny how the worst problem cases I run into are usually old AARP med sups. I guess representing yourself isn't always the best idea.

 

[retread]

Also, if this prospect does in fact have the "closed" Plan J with embedded Rx coverage, upon changing to a MAPD, or, stand alone PDP, etc, they would pay the Part D late enrollment penalty as "closed" Plan J is not considered creditable coverage.
You need to be sure to do a through fact finding. Specifically, what Med Supp policy is this person on????

Yoda was spotted selling PDP's at WalMart.

Dayton is right on the money... she will more than likely have a LEP applied to any drug plan, whether MA-PD or stand-alone PDP. THEN, if she opts out after less than a year, she can go back to her old plan, but sans drug coverage. She will HAVE to get a PDP, and again, be subject to the LEP.

The advice is correct to leave her be. As long as she doesn't change anything, she can continue with her pre-standardized J with Rx coverage. The minute she leaves it, though, she can't go back and still have the Rx benefit. Her ability to go back to the old plan is guaranteed under the trial right to less than 12 months in an MA plan, but not the Rx coverage.