MAPD and ESRD Question

Jan 22, 2019

  1. axeman462
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    axeman462 Guru

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    I initially thought that too, but my research (and even backed up by UHC underwriting), is coming up that other MAPD carriers could deny her due to the ESRD.
    I even asked about a medsupp, and they (UHC) told me she would get denied.

    Not that it makes much of a difference in this particular case though. Her doctors don't accept a whole lot of plans (there is also not a lot available in the county she lives in), and UHC is coming up as the best choice for her. But, these rules seem to have a lot of different interpretations...
     
  2. Mike Siegal
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    Mike Siegal Super Genius

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    I'm not getting this. I read she is covered.

    LINK

    Please advise...(hope you can get her coverage)


    .
     
  3. axeman462
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    that link looks to be talking mostly about Original Medicare by itself. Not MAPD or medsupps.
    Original Medicare by itself is not an issue. I am talking about MAPD or medsupps. Which can/do have limited underwriting.
     
  4. TwoCents
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    TwoCents Guru

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    Well, having an election (the move) to enroll and having an exception to the ESRD status are 2 different things. Sure, ignore the info I posted from the CMS guidelines. Also, for what it's worth, on their electronic app, if a person answers YES to having ESRD then a series of questions come up. One is "Are you currently enrolled in another health plan that Humana offers in your state?" The answer to that would be NO in this situation. Answering no to the others (coming from a non-renewing plan, had a successful transplant) as well, and you get a nice little message "You are ineligible to enroll." Like I said, moving to a different state is a dumb little rule, but a rule nonetheless.

    Edit to say this is for MA.

    Edit 2: the app I'm referring to is Humana, not sure about UHC.
     
    Last edited: Jan 23, 2019
  5. axeman462
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    I get what you are saying. All I can do is repeat what UHC PHD has told me. according to PHD, they will accept her, since it is a UHC to UHC plan change.

    I have never tried to write someone with ESRD before. like I said before, it is going to be an interesting conversation with her on Friday. I should know I assume Tuesday if it gets accepted or not. (I usually do paper apps, and wont be submitting it until Saturday or Monday, because I have to travel for this appt.)
     
  6. axeman462
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    The application is still pending. Talked to UW yesterday, they are just trying to confirm that she has/had UHC prior to this application. I was told once it is confirmed, it will be issued. Hoping to hear something more later today, as the issue date is tomorrow...
     
  7. TwoCents
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    Translation: Someone in the enrollment dept is checking with someone in compliance and it's going to be a no go. It shouldn't take but a second to see she had UHC.

    Edit to add: I would recommend writing a PDP app TODAY to keep on hand so she can get a 2/1 start date on it.
     
  8. axeman462
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    axeman462 Guru

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    UPDATE: ITS APPROVED AND ISSUED!!!
     
  9. TwoCents
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    TwoCents Guru

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    Color me shocked. Until she gets the letter in the mail saying it's approved, I wouldn't pop the champagne just yet. Not to sound like a sore loser, but if you come across this situation again in the future, the outcome may be different. Just sayin'.
     
  10. JustinTime
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    I'm know I'm late in sharing these, but I thought a link to these guaranteed issue rights for Medicare Supplements as well as different election periods for Medicare Advantage / PDP might help clear some things up for the future:

    Medicare Supplement - guaranteed issue rights
    Guaranteed issue rights | Medicare

    Medicare Advantage / PDP - election periods
    Joining a health or drug plan | Medicare
    Special circumstances (Special Enrollment Periods) | Medicare
    5-star special enrollment period | Medicare

    In case anybody would like to have it, the 2019 Choosing a Medigap Policy booklet has recently been released:
    https://www.medicare.gov/Pubs/pdf/02110-Medicare-Medigap-guide.pdf
     
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