OEP Question.....

[medicarebenefitsdirect]

Am I correct in saying that you can NOT move someone on a MAPD back to Original Medicare and a Med Supp after Dec. 31? I know you can move them from an MA to Original Medicare and a supp. I am hearing a lot of conflicting info. on this....

 

[Joe Moore]

Am I correct in saying that you can NOT move someone on a MAPD back to Original Medicare and a Med Supp after Dec. 31? I know you can move them from an MA to Original Medicare and a supp. I am hearing a lot of conflicting info. on this....

You CAN move them to Original Medicare AND a Medicare Supplement. But they must purchase a stand alone PDP.
You cannot add or subtract a Part-D during the OEP.

Here is a good chart to explain most available changes:
http://www.benefitportonline.com/files/Industry_News/Enrollment_Plan_Switch_Clarification.pdf

 

[toc3]

Thanks for that Link Joe, that is very helpful.

 

[retread]

Am I correct in saying that you can NOT move someone on a MAPD back to Original Medicare and a Med Supp after Dec. 31? I know you can move them from an MA to Original Medicare and a supp. I am hearing a lot of conflicting info. on this....

Where are you "hearing a lot of conflicting info. on this"?

It certainly is not on this forum... every time somebody posts this question it is resoundingly addressed just as Joe Moore did in the above post. Most of us that have been selling MA plans for the last several years know the rules and try to nip any misunderstanding of these rules in the bud immediately. There is no conflict about this rule on this forum to my knowledge.

Let me make it perfectly clear:

1)Outside of the ICEP or certain SEPs, no one can initially enroll in a MSA or PDP except during the AEP. 2)If a MSA is not enrolled in the AEP, the door is shut until next AEP
3)For those enrolled in a PDP on 12/31, they cannot "pick up or drop" a PDP during the OEP. {"pick up or drop" means initially enroll in, or drop coverage of}
4)The OEP is a "buyer's remorse" opportunity... but if you came into the OEP with drug coverage, you must leave with drug coverage.

Therefore, since MAPDs incorporate a PDP, to reverse a MAPD plan for a Med Sup client, you will HAVE TO sell a stand-alone PDP along with the recission, and then they will be made whole again.

The point being, that even if the client did not have a PDP with his Med Sup before the AEP, if he bought a MAPD plan during the AEP, by default he bought a PDP.... so to go back to what he had the previous year, he will need to enroll in a PDP when he goes back to his Med Sup. NOONE can drop a PDP to pick up another during the OEP... that's switching, and the property of the AEP. But in the case of MAPDs, since the PDP is embedded, to go back to OM + MS during the OEP, to conserve the PDP, another PDP must be chosen.

 

[toc3]

Very well said Retread. I know I did not post this thread but you have cleared up some things for me. It is not even explained this well in the Health guide to choosing a Medigap policy book. Thanks

 

[The Hunter]

How about this twist. I enrolled a client in a MAPD. The Client never had a PDP and is in the penalty phase for at
least the last 2 years. She has always paid for drugs out of pocket and she is not sure she wants to pay a penalty for
a PDP . The MAPD is $0 premium. Of course I told her she is better off paying the penalty and have a PDP. If she still does not want the PDP Should I rewrite her a MA only before
12/31 or could she still enroll in a MA after AEP if she rejects
paying the penalty for the PDP portion.

 

[retread]

How about this twist. I enrolled a client in a MAPD. The Client never had a PDP and is in the penalty phase for at
least the last 2 years. She has always paid for drugs out of pocket and she is not sure she wants to pay a penalty for
a PDP . The MAPD is $0 premium. Of course I told her she is better off paying the penalty and have a PDP. If she still does not want the PDP Should I rewrite her a MA only before
12/31 or could she still enroll in a MA after AEP if she rejects
paying the penalty for the PDP portion.

MA only plans can be sold:
1)during the ICEP
2)during the AEP
3)during the OEP

So, to answer your question another way, you can sell "MA only" plans from Nov15th to March 31st.

I have had several clients balk at paying the "penalty" because they don't use drugs (or only a few generics).

I answer their objections this way:

1) The "penalty" is only 30c/mo... not an outrageous amount. (Just using the word "penalty" without putting a number on it sounds a lot scarier than it really is)
2) The longer you postpone getting this settled, the higher the amount accumulates... $3.60/yr.... FOR LIFE!
3) The older you get, the more likely you will need Rx... modern Rx is what is driving longer life expectancy.
4) Bite the bullet now while your "penalty" is smallest and get it over with. Sign here.

 

[The Hunter]

Thank you Retread. I appreciate your response and that is exactly how I will approach this Client

 

[jdeasy]

How about this twist. I enrolled a client in a MAPD. The Client never had a PDP and is in the penalty phase for at
least the last 2 years. She has always paid for drugs out of pocket and she is not sure she wants to pay a penalty for
a PDP . The MAPD is $0 premium. Of course I told her she is better off paying the penalty and have a PDP. If she still does not want the PDP Should I rewrite her a MA only before
12/31 or could she still enroll in a MA after AEP if she rejects
paying the penalty for the PDP portion.

If she truly does not want the PDP, you must get her disenrolled before Dec. 31.

You cannot re-write her into an MA only after Jan. 1 if she keeps MAPD past Dec. 31.

 

[medicarebenefitsdirect]

Retread...

Thanks for clearing that up. I was not hearing conflicting info on here but from an FMO. You made that very clear. Thanks again!