Just because VA is creditable, does not mean it IS a Part D Medicare plan.... it ISN'T. The "like to like" comparison means a "Part D to Part D" plan. An MAPD is "like" a Stand Alone PDP in serving prescription coverage. Group insurance with Rx coverage may be creditable, but it is not "like" a PDP either.
OEP & VA Question
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Just because VA is creditable, does not mean it IS a Part D Medicare plan.... it ISN'T. The "like to like" comparison means a "Part D to Part D" plan. An MAPD is "like" a Stand Alone PDP in serving prescription coverage. Group insurance with Rx coverage may be creditable, but it is not "like" a PDP either.
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That's why I called Medicare to get claification about making the change. They assured me that this was an option for him during OEP. It is a like to like change. I know Medicare isn't always correct in the info they give out, I don't know what to believe now. I wrote down the woman's name from Medicare, the date and time that I spoke with her....any suggestions on making doubly sure that this is an allowable change?
You should be able to tell from my comments that I am with Rick on this one. I don't think it will be allowed.
HOWEVER... what's going to happen if it is disallowed? He won't be any worse off, but at least you tried.
If you are successful and since he has been on a MA plan for over a year, he won't have GI for a Med Sup, but that doesn't mean he can't apply for one, either.... he may just have to pass UW. (I say MAY because some carriers want the business bad enough that they will waive the health questions, so I have heard.)
Who monitors this? I have switched several MAPD back to Original Medicare and a Med Sup and nobody asks if they took out another PDP. I realize that during OEP they are supposed to, but who is monitoring this and has anyone ever been asked by the Med Sup company if the client also got a stand alone PDP? Does Medicare contact them months later saying they were supposed to have a PDP, so go join one retroactively? Good luck with that.
I think they can go to just VA, since they probably never actually disenrolled from VA and...nobody is monitoring it and whatever happens the client has drug coverage at the VA and can go back to a PDP January 1. Many PDP clients also go to the VA. They never disenroll from the VA and use both for their prescriptions. Is that allowable? No, but it is done a lot.
And if the client is within the 12 month period and it is their first MA plan they can switch regardless of enrollment period.
I think they can go to just VA, since they probably never actually disenrolled from VA and...nobody is monitoring it and whatever happens the client has drug coverage at the VA and can go back to a PDP January 1. Many PDP clients also go to the VA. They never disenroll from the VA and use both for their prescriptions. Is that allowable? No, but it is done a lot.
And if the client is within the 12 month period and it is their first MA plan they can switch regardless of enrollment period.
Chuck, you lay open the situation.... and you are spot on. However, your statement "They never disenroll from the VA and use both for their prescriptions. Is that allowable? No, but it is done a lot." ... is inaccurate. It IS allowable. Just check the link in my prior post...
I really don't see any downside (as far as the beneficiary is concerned) with just disenrolling the client from the MAPD and let him have OM and VA, if that is what he wants. Of course, the agent that enrolled him will lose out....
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Won't they consider him being in an MAPD a lock in and he can't change during OEP unless it's a like to like? It's really frusterating to not be able to count on what Medicare tells us. I was told that this is a like to like change and he can move by Medicare
A really simple way to resolve this is just apply for it and find out.
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I like to know up front if it's something we can do or not. I can't just say to my client, let's give it a shot and see what happens. I think the client expects the agent to have the knowledge and they want to trust what you're telling them. It's kind of hard when the insurance companies and Medicare both give you different answers. Heck, both of them don't seem to know that you can take out a PDP plan during OEP, you have to make them look up the rules.
It appears you have reached a stale-mate. Unless you have a better idea, my advice stands.
A cut and paste from the VA:
In addition, a veteran may want to consider the flexibility afforded by enrolling in both VA and Medicare. For example, veterans enrolled in both programs would have access to non-VA physicians (under Medicare Part A or Part B) or may obtain prescription drugs that are not on the VA formulary if prescribed by non-VA physicians and filled at their local retail pharmacies (under Medicare Part D).
Veterans should also be mindful of the late enrollment penalties in Medicare Part B and Part D that are imposed on those who do not enroll in Medicare during their initial enrollment period. VA health care is recognized as creditable coverage for Medicare Part D (prescription drug program) but it is NOT creditable coverage for Part B (outpatient health care, including doctors' fees). So although a veteran may avoid the late enrollment penalty for Part D by citing VA health care enrollment, that enrollment would not help them avoid the late enrollment penalty for Part B.
In addition, a veteran may want to consider the flexibility afforded by enrolling in both VA and Medicare. For example, veterans enrolled in both programs would have access to non-VA physicians (under Medicare Part A or Part B) or may obtain prescription drugs that are not on the VA formulary if prescribed by non-VA physicians and filled at their local retail pharmacies (under Medicare Part D).
Veterans should also be mindful of the late enrollment penalties in Medicare Part B and Part D that are imposed on those who do not enroll in Medicare during their initial enrollment period. VA health care is recognized as creditable coverage for Medicare Part D (prescription drug program) but it is NOT creditable coverage for Part B (outpatient health care, including doctors' fees). So although a veteran may avoid the late enrollment penalty for Part D by citing VA health care enrollment, that enrollment would not help them avoid the late enrollment penalty for Part B.
