Medicare Advantage Auto Enroll for U65's

[kgmom219]

According to Cornell Law, seamless enrollment has been permitted at least since 2006, pre-dating Obamacare.

Seamless continuation
In applying section 1395w-21 (c)(3)(A)(ii) of this title, an individual who is enrolled in a health benefits plan shall not be considered to have been deemed to make an election into an MA-PD plan unless such health benefits plan provides any prescription drug coverage.
https://www.law.cornell.edu/uscode/text/42/1395w-131

Also outlined in the Medicare Manual, Section 40.14 on page 52

Jen, just continuing to pad my post count .........

Where ya been?

All I said was I hadn't run across it and you went after me. Geez.

And my reps also said it was new.

And I still maintain its wrong and causing massive problems

 

[WCMason]

Where ya been? All I said was I hadn't run across it and you went after me. Geez. And my reps also said it was new. And I still maintain its wrong and causing massive problems

With respect, you did indicate that he was padding his post count and had made it up, though perhaps kiddingly.

It's not new. I have run into it frequently since I started writing Medicare health plans three years ago. It's pretty common given how many T65 have an under 65 individual BCBS PPO plan in Texas.

It's not really wrong if the rules specifically allow it, and they do. But if you mean it is wrong meaning it doesn't serve the people the rule was created to help, I agree with that. Many rules are well intended with unintended consequences and I agree this is one of them. I've only had one person I met with decide to stay with the auto-enrolled PPO.

What I've never been clear on is timing. If I write them a PDP three months prior to effective, will the auto-enroll displace that? It hasn't happened yet, but unsure on how that works.

 

[kgmom219]

With respect, you did indicate that he was padding his post count and had made it up, though perhaps kiddingly.

I was totally teasing him and he knew it. And vice versa. However, I also can see how someone would see it differently.

I agree its allowed and it was pre ACA. Bob convinced me.

I still think its BS. And mine aren't getting enrolled onto a PPO. Its a crappy MAPD with a lousy network and limited (bad formulary) RX coverage. Then I've got clients screaming about being on an HMO (since they think the devil created them) and I can't cancel it. They have to do it themselves. And the feedback I'm getting is that they feel very pressured to stay, but they are already pissed when they call, so who really knows. I ask for emails to send on, but I never get them. Hmmm.....

To answer your question, if I enroll someone in a Part D 60-90 days out, they don't seem to be auto enrolled. The enrollment and letters are triggered around day 60. (This is BCBSTX ONLY.) So the Part D should take precedence over the auto enroll.

 

[somarco]

The devil did create HMO's, shortly after he told Adam to eat anything Eve offered him.

KG, your rep was wrong. Yeah, I know. Shocking. That never happens.

Part D should take precedence over the auto enroll.

Never assume ...........

WC, kgmom and I have a special relationship. She considers me an old crab and I talk about the broom she rides.

Thanks to both of you for giving me yet another opportunity to increase my post count. I'll be dead and gone for years before anyone catches me.

 

[kgmom219]

The devil did create HMO's, shortly after he told Adam to eat anything Eve offered him.

KG, your rep was wrong. Yeah, I know. Shocking. That never happens.

Never assume ...........

WC, kgmom and I have a special relationship. She considers me an old crab and I talk about the broom she rides.

Thanks to both of you for giving me yet another opportunity to increase my post count. I'll be dead and gone for years before anyone catches me.

Watch out...I might just get on my broom, fly to GA and put a hex on your house....the hex will send Taters clients (I know how much you love Taters clients) to your house asking for their free Obamacare

 

[taterpeeler]

Watch out...I might just get on my broom, fly to GA and put a hex on your house....the hex will send Taters clients (I know how much you love Taters clients) to your house asking for their free Obamacare

Get yer Obamacare.... at ObamaCareEasy.com.... go Bob... time to stop complaining about the law and certify.... let go man

 

[sman]

She considers me an old crab

Doesn't everyone?

 

[AllenChicago]

According to Cornell Law, seamless enrollment has been permitted at least since 2006, pre-dating Obamacare.

Seamless continuation
In applying section 1395w–21 (c)(3)(A)(ii) of this title, an individual who is enrolled in a health benefits plan shall not be considered to have been deemed to make an election into an MA–PD plan unless such health benefits plan provides any prescription drug coverage.
https://www.law.cornell.edu/uscode/text/42/1395w-131

Also outlined in the Medicare Manual, Section 40.14 on page 52

Jen, just continuing to pad my post count .........

10.6.2016

I came across http://www.eacourier.com/news/some-...cle_8966f0f0-8b24-11e6-bcaa-535a51b75afc.htmlSome seniors surprised to be automatically enrolled in Medicare Advantage plans | Local News Stories | eacourier.com this evening and thought BCBS was breaking the law. Thankfully this thread exists, and you (Somarco) have proven that its legal for insurers to enroll their T-65 IFP (and group?) customers in an in-house Medicare Advantage plan.

Luv this forum!

-ac

 

[somarco]

Thank you for the kind words, AC. You might find this of interest. Seems the gray panther advocates are restless.

Beneficiary advocates raised concerns about an apparent uptick in the frequency of seamless conversion practices and about the risks associated with passive enrollment practices that do not require any affirmative actions on the part of enrollees. Particularly because conversion notices are sent just prior to a person’s Medicare eligibility, when they are likely to receive significant quantities of mail advertising Medicare products, it is easy to imagine how a person could skip over or misunderstand a seamless conversion notice.

Not understanding one’s enrollment status poses significant risks to beneficiaries. For example, a person unknowingly enrolled in a Medicare Advantage plan may inadvertently receive care from an out-of-network provider, potentially leading to significant out-of-pocket health care costs.