Need Guidance with IEP Rules

Jul 6, 2016

  1. melmadhav
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    melmadhav Expert

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    I have a client whose Medicare eff date was 6/1/16. For various reasons he wanted an 8/1/16 eff date on his MAPD. I submitted the app as such on 6/23/16. Per UHC, CMS gave him a 7/1 eff date instead of the requested 8/1 eff date and stated that CMS gives the next available effective date.

    If the election period is valid for 3 months after the Medicare eff date one would think that they would honor the 8/1 request!?!? Am I wrong to assume this? Any suggestions on getting it fixed?

    TIA!
     
  2. senior-advisor-indiana
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    senior-advisor-indiana Guru

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    Yes, you are wrong.....
     
  3. melmadhav
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    melmadhav Expert

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    errrrr, lesson learned, thanks!
     
  4. alphawave2k
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    alphawave2k Super Genius

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    Done deal, but for future reference. If you had submitted his app the month prior to his preferred start date (and as long as he didn't have a birthday fall on the 1st of the month), his coverage would have started the month of preference. You'd have to keep in mind they would still within their IEP time frame of 3 months after his birthday month.

    PS what harm will he suffer if the plan starts one month earlier??
     
  5. WCMason
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    WCMason Guru

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    They assign the first effective date he's eligible for, not the date requested. You applied too early to meet the client's request.
     
    WCMason, Jul 6, 2016
    #5
  6. TwoCents
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    TwoCents Guru

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    Very few elections allow for an effective date to be chosen. More times than not the application must be processed for the first of the following month.
     
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