New SEP Guidelines for Duals 2019

[JaBrooklyn]

Now I am confused, is it only for Part D's or also SNP plans?

Also, how would it work with a SEP /state exemptions? NY you can create an SEP by enrolling in NY State EPIC plan, would that also have to wait until quarter end?

Government always screws things up.

Cant wait for this conversation "Grandma needs this drug asap, she is dual and living on a fixed income. Can she switch to silverscript for Feb 1st since it is in the formulary?" NOPE, grandma has to wait 90 days.

 

[goillini52]

Says it at CMS.

2018-04-02 - Centers for Medicare & Medicaid Services

That's not good. Not the end of the world, but could disqualify a sale here or there.

Actually now that I think about it, could help brokers with retaining. But, I know many captives that sell almost only dual/LIS and this can hurt...

I must be blind. I looked that over and I couldn't see it. Could you post where it says Medicare says that accessing medicare.gov on behalf of the member is actually illegal.?

 

[MedicareMillionair]

View attachment 4522
and I wonder how the heck are we supposed to know if someone already used their once every quarter SEP? head banging mess

They typically don’t change these plans, so shouldn’t be an issue.

 

[JaBrooklyn]

Towards the middle/bottom..

"Limitation to the Part D Special Enrollment Period for Dual and Other LIS-Eligible Beneficiaries
To ensure that Part D plan sponsors are better able to administer benefits, including coordination of Medicare and Medicaid benefits, we are revising the Special Election Period (SEP) for dual-eligible and LIS beneficiaries from an open-ended monthly SEP to one that may be used only once per calendar quarter during the first nine months of the year. The final rule also establishes separate SEPs that can be used in the following circumstances: (1) within a certain period of time after a CMS or state-initiated enrollment; and (2) within a certain period of time after a change to an individual’s LIS or Medicaid status"

 

[YouGotMyMoney]

Now I am confused, is it only for Part D's or also SNP plans?

Also, how would it work with a SEP /state exemptions? NY you can create an SEP by enrolling in NY State EPIC plan, would that also have to wait until quarter end?

Government always screws things up.

Cant wait for this conversation "Grandma needs this drug asap, she is dual and living on a fixed income. Can she switch to silverscript for Feb 1st since it is in the formulary?" NOPE, grandma has to wait 90 days.

They are saying you can only use the LIS/DUAL SEP Code(s) once every 3 months. If you were to use a different election such as SPAP (EPIC NY), then you would be fine.

 

[Todd King]

Towards the middle/bottom..

"Limitation to the Part D Special Enrollment Period for Dual and Other LIS-Eligible Beneficiaries
To ensure that Part D plan sponsors are better able to administer benefits, including coordination of Medicare and Medicaid benefits, we are revising the Special Election Period (SEP) for dual-eligible and LIS beneficiaries from an open-ended monthly SEP to one that may be used only once per calendar quarter during the first nine months of the year. The final rule also establishes separate SEPs that can be used in the following circumstances: (1) within a certain period of time after a CMS or state-initiated enrollment; and (2) within a certain period of time after a change to an individual’s LIS or Medicaid status"

What does this have to do with agents accessing Medicare.gov for a client or not?

Nothing in there about that at all. Maybe we have 2 different discussions going on here?

 

[Todd King]

nope. this is just what we were told. the company made a big deal out of it, because they found out I was doing it, and they said they contacted Medicare and multiple companies and everyone told them that I/we weren't allowed to do this.

If that's not the case then it will make things much easier!

If it was the call center that told you that, then I can understand why they wouldn't want you doing this. I would think f2f would be better. Either way, I think "they" lied to you.

 

[XpressInsurance]

Towards the middle/bottom..

The question we are looking for an answer to is "Is it illegal for an agent to go to medicare.gov & use check your enrollment tool. The page you linked does not address it.

I personally don't think it is illegal or prohibited with the beneficiary's permission. It is not providing claim information, medications just what plan they are enrolled in & current subsidy level. I know the national call center I worked at for over 7 years, used the check your enrollment tool. I also know that we sent the sales & enrollment calls to the carrier. I would have thought someone in one of the compliance departments would have caught it if it were an illegal or prohibited action. I would often go to medicare.gov while they were on phone & then say medicare.gov shows you enrolled in XYZ all recorded & sent to carrier.

 

[Todd King]

It just occurred to me that justsayinisall may be getting it mixed up with actually enrolling someone through Medicare.gov....like a PDP plan or something.

 

[justsayinisall]

It just occurred to me that justsayinisall may be getting it mixed up with actually enrolling someone through Medicare.gov....like a PDP plan or something.

no not confused. I was told I couldn't access client info via medicare.gov even with the clients permission. Not in the call center, this was the last job that was a captive, outbound sales agent.

But I'm going to go with what everyone else is saying and forget I learned that lol