Needs Some Help on This

[VaDwayne]

I am working with a family on their med supps and I need some advice.

Mr ????? 69 years old and just lost his major medical coverage at work. He enrolled in a MA PFFS( Secure Horizons) because of a friend. He enrolled in the MA just a month ago so he can do a rapid disenrollment(thanks Todd) within 90 days, and he is going to pick up a med supp from me.

Question? His Part B effective date is 3-01-2009, is he GI? I would say yes because his disenrollment would be as if he never had the MA to start with, and he is within 6 months of enrolling in Part B, am I correct?

Mrs???? She is 61 and disabled. She was also reffered by a friend to enroll in a Humana PFFS and she hates it because she say's that she never knows what her out of pocket expenses will be, and she is convinced that Humana sucks. Someone had already told her that Humana is dropping their PFFS.

Her part B effective date was 3-1-2009 also. What are my options with this lady? Can I switch her to another MA and must I wait until Nov. 15th to do so. She did not have a med supp before the MA.

Any hope for a med. supp here or will she have to wait until OEP when she turns 65?

 

[LoriRutl]

I am working with a family on their med supps and I need some advice.

Mr ????? 69 years old and just lost his major medical coverage at work. He enrolled in a MA PFFS( Secure Horizons) because of a friend. He enrolled in the MA just a month ago so he can do a rapid disenrollment(thanks Todd) within 90 days, and he is going to pick up a med supp from me.

Question? His Part B effective date is 3-01-2009, is he GI? I would say yes because his disenrollment would be as if he never had the MA to start with, and he is within 6 months of enrolling in Part B, am I correct?

Is it MA or MAPD? MA, then yes. Otherwise he will have to go without Drug coverage until Jan. 1.

Mrs???? She is 61 and disabled. She was also reffered by a friend to enroll in a Humana PFFS and she hates it because she say's that she never knows what her out of pocket expenses will be, and she is convinced that Humana sucks. Someone had already told her that Humana is dropping their PFFS.

I believe that is correct in VA.

Her part B effective date was 3-1-2009 also. What are my options with this lady? Can I switch her to another MA and must I wait until Nov. 15th to do so. She did not have a med supp before the MA.

Any hope for a med. supp here or will she have to wait until OEP when she turns 65?

Unless she qualifies for LIS, she will have to wait until AEP (Nov. 15 to Dec. 31).

PM me if you want to talk.

 

[jdeasy]

I am working with a family on their med supps and I need some advice.

Mr ????? 69 years old and just lost his major medical coverage at work. He enrolled in a MA PFFS( Secure Horizons) because of a friend. He enrolled in the MA just a month ago so he can do a rapid disenrollment(thanks Todd) within 90 days, and he is going to pick up a med supp from me.

Question? His Part B effective date is 3-01-2009, is he GI? I would say yes because his disenrollment would be as if he never had the MA to start with, and he is within 6 months of enrolling in Part B, am I correct?

Mrs???? She is 61 and disabled. She was also reffered by a friend to enroll in a Humana PFFS and she hates it because she say's that she never knows what her out of pocket expenses will be, and she is convinced that Humana sucks. Someone had already told her that Humana is dropping their PFFS.

Her part B effective date was 3-1-2009 also. What are my options with this lady? Can I switch her to another MA and must I wait until Nov. 15th to do so. She did not have a med supp before the MA.

Any hope for a med. supp here or will she have to wait until OEP when she turns 65?

You have several things going on here and not quite full information.

First, the husband. When did he lose his major medical from work? If it was creditable coverage, he is GI for a med sup for 63 days. He does not have 6 months from the date of his part B effective date since he was not 65 in that month.

Did he enroll in an Ma only and a stand alone PDP or did he enroll in an MAPD? Either way he can get out if he is within the 63 days.


For the wife. Did she also just lose creditable coverage? She is correct in thinking that Humana sucks, but, that doesn't solve her problem. She is in an MAPD since Humana doesn't have a stand alone MA PFFS. Humana is not dropping their PFFS, so, she is out of luck there. If she just enrolled because she lost creditable coverage, she can get out. If she didn't, she will have to qualify for another SEP or she is "locked in" thru AEP. There are 65 SEP's available. See if she qualifies for one.

 

[LoriRutl]

Humana is not dropping their PFFS, so, she is out of luck there.


Humana IS dropping the PFFS in some States. West Virginia is one. Not sure where else.

 

[jdeasy]

Humana is not dropping their PFFS, so, she is out of luck there.


Humana IS dropping the PFFS in some States. West Virginia is one. Not sure where else.

OK, Humana is not dropping PFFS as a company the way Wellcare and Coventry are dropping PFFS.

They are ending PFFS plans in some service areas. If she is lucky enough to be in one of those areas she can get out of the Humana plan as eary as Nov. 1. If she has to go that route, at least that's 2 months away from Humana.

 

[jdeasy]

double post