MAPD and ESRD Question

Jan 22, 2019

  1. axeman462
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    axeman462 Guru

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    have an intersting case here, that I need to confirm a few things.

    She has Stage 5 Kidney Disease (ESRD) currently on an MAPD PPO, and moved to Florida. (so she qualifies for an SEP). because she is currently on MAPD, she can still switch to a new MAPD correct?
     
  2. Todd King
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    Todd King IMO/FMO Owner

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    Yes she can.
     
  3. DS4
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    ............................
     

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    DS4, Jan 22, 2019
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  4. TwoCents
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    No. If she's on an MAPD offered in Georgia that isn't offered in Florida, she won't be able to choose a new MAPD plan even if it's with the same company. It's a pretty dumb rule. From the official CMS guidelines, not some blurb from a website:

    Once enrolled in an MA plan, a person who has ESRD may elect other MA plans in the same MA organization (and during allowable enrollment request periods, as described under §30.). However, the member would not be eligible to elect an MA plan in a different MA organization or a plan in the same MA organization in a different State.
     
    TwoCents, Jan 22, 2019
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  5. Todd King
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    As long as she still qualifies for that SEP then that's going to negate just about any rule saying she can't have one. I think that should probably be your starting point.
     
  6. TwoCents
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    Hopefully, OP will let us know how this one plays out.
     
    TwoCents, Jan 22, 2019
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  7. axeman462
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    just talked to UHC PHD, they basically confirmed everything said here. Her only real options are to switch to a florida based UHC MAPD, or have oringal medicare by itself (and a PDP).
    Gonna see her on Friday, this should be an interesting conversation..
     
  8. TwoCents
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    If you write the FL UHC MAPD, let us know if it actually gets accepted by CMS. I have my doubts.
     
    TwoCents, Jan 23, 2019
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  9. jerkstore
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    Moving out of area should allow her a SEP to switch to anything.

    ESRD by itself would only allow for a move within same carrier.

    Am I wrong about ^^?
     
  10. Todd King
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    No, you are correct in your thinking.
     
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