OEP & VA Question

[thebrit]

Which insurance carrier are you going to put him for his med supp? the reason I ask that is if you have an app in front of you it is going to ask the questions of previous coverage,you will check the boxes and when it asks about presciptions,you will state he has VA and enter his VA#...thats as good as creditible cover....I am I right or wrong..I await all replies

 

[patch36]

The med sup apps I know only ask about previous coverage - if it is an MA and if it was the first time they were in an MA and when did they enroll. Nothing about the drug plan is asked by a Med Sup, nor do they care about Prescription Drug Plans in general. I don't know who bothers to police this, but it is not the Med Sup companies.

VA is creditable coverage. The worse that will happen is the client will have to sign up for a PDP sometime in the future. I do not see that happening based on the VA being creditable coverage.

 

[retread]

The med sup apps I know only ask about previous coverage - if it is an MA and if it was the first time they were in an MA and when did they enroll. Nothing about the drug plan is asked by a Med Sup, nor do they care about Prescription Drug Plans in general. I don't know who bothers to police this, but it is not the Med Sup companies.

VA is creditable coverage. The worse that will happen is the client will have to sign up for a PDP sometime in the future. I do not see that happening based on the VA being creditable coverage.

VA benefits are a function of Congressional budgets. If it came to it, and Congress ran out of funds for some VA benefits, some vets might be disenrolled from the program. Since VA benefits are creditable, they would not have a penalty if they then enrolled in a Part D plan, so they are not exposed to any additional financial risk by deferring Part D at this time, other than the fact they might save some money on Rx if they were dual enrolled.... but this would be for those vets with big Rx numbers.

On the same subject, did you guys get my memo that Priority Group 8 is opening back up in June?

 

[jdeasy]

I have a situation now where a guy was in Humana's MAPD for 2008. It was $0 premium in his county last year. It went to $48/mo for '09. He told the Humana agent he did not want to pay a premium. The agent put him in the PPO with zero premium, but, it does not have drug coverage. The guy wanted to keep drug coverage. He insists that the agent did not tell him that the zero premium PPO didn't have drugs. I'm sure he is telling the truth as he didn't know he didn't have drug coverage until I told him.

He does have VA benefits. He wanted the PDP though, so he could get meds at a local pharmacy.

I was of the understanding that I could not enroll him in an MAPD or stand alone PDP now. This thread seems to say that I can, if I am understanding it.

None of the charts that show what is allowable has this situation on it. I would like to help this guy out. Could someone show me where it is allowed?

 

[thebrit]

No you cannot change him to an MAPD,he made the election to go MA,and the Humana rep probably used his VA benefits as coverage for meds(pdp).He will probably have a case with CMS to go back to a MAPD,but you are left with lots of phone calls to CMS to get the right person to speak to...his OEP election has to be like for like.This thread was taking someone from MAPD to Med Supp,the dispute was PDP coverage,that is a whole different story

 

[retread]

I have a situation now where a guy was in Humana's MAPD for 2008. It was $0 premium in his county last year. It went to $48/mo for '09. He told the Humana agent he did not want to pay a premium. The agent put him in the PPO with zero premium, but, it does not have drug coverage. The guy wanted to keep drug coverage. He insists that the agent did not tell him that the zero premium PPO didn't have drugs. I'm sure he is telling the truth as he didn't know he didn't have drug coverage until I told him.

He does have VA benefits. He wanted the PDP though, so he could get meds at a local pharmacy.

I was of the understanding that I could not enroll him in an MAPD or stand alone PDP now. This thread seems to say that I can, if I am understanding it.

None of the charts that show what is allowable has this situation on it. I would like to help this guy out. Could someone show me where it is allowed?

thebrit is right (if he is speaking to your case). If another agent switched your client to a MA only plan, leaving him without a PDP during the AEP, then it is too late to switch him back to a MAPD. He will have to live with what he's got until next AEP.

Just remember: the AEP is basically for PDPs. MAs can be enrolled from 11/15 to 3/31, but PDPs and MAPDs can only be enrolled during AEP. ONCE IN A PDP or MAPD, you can switch during the OEP, but you cannot pick up or drop a PDP plan during the OEP.

 

[jdeasy]

thebrit is right (if he is speaking to your case). If another agent switched your client to a MA only plan, leaving him without a PDP during the AEP, then it is too late to switch him back to a MAPD. He will have to live with what he's got until next AEP.

Just remember: the AEP is basically for PDPs. MAs can be enrolled from 11/15 to 3/31, but PDPs and MAPDs can only be enrolled during AEP. ONCE IN A PDP or MAPD, you can switch during the OEP, but you cannot pick up or drop a PDP plan during the OEP.

That's what I thought. I didn't think I could change him to the MAPD and use the VA as creditable coverage during OEP.

I must have misread this thread as I thought someone was saying that you could.

I was asking for clarification. Thanks to all for providing that.

 

[insurance0707]

That's what I thought. I didn't think I could change him to the MAPD and use the VA as creditable coverage during OEP.

I must have misread this thread as I thought someone was saying that you could.

I was asking for clarification. Thanks to all for providing that.

Yes, someone was saying that you could switch, it was Medicare. I called them directly and they told me "Yes, it is a like to like change and they considered the VA creditiable prescription coverage" Now when the case gets rejected and I have to call Medicare again who knows what there response will be.

 

[retread]

Yes, someone was saying that you could switch, it was Medicare. I called them directly and they told me "Yes, it is a like to like change and they considered the VA creditiable prescription coverage" Now when the case gets rejected and I have to call Medicare again who knows what there response will be.

That's why I advise, submit the plan and see if it flys. You never know... but we do know that they don't know their own rules.

 

[insurance0707]

That's what I did retread.....I'll let you know what happens