PDP enrollment period...

[sshafran]

He is 67, his wife 66...

Retired in Feb, last day of group was end of Feb.

Med A effective 9/1
Med B effective 3/1

Pretty sure the ship has sailed on getting a PDP. He would have had to either use Delayed B (w/enrollment prior to 3/1) OR use the employer group SEP, which expired @ end of April.

In Ohio - no SEPs for his county that I could find. Not LIS or anything like that. Any ideas?

 

[sshafran]

He is 67, his wife 66...

Retired in Feb, last day of group was end of Feb.

Med A effective 9/1
Med B effective 3/1

Pretty sure the ship has sailed on getting a PDP. He would have had to either use Delayed B (w/enrollment prior to 3/1) OR use the employer group SEP, which expired @ end of April.

In Ohio - no SEPs for his county that I could find. Not LIS or anything like that. Any ideas?

Spoke too soon. I had looked on Jarvis for SEPs. Just found a WellCare email with a tornado SEP all counties for March 14. Winner winner chicken dinner - that should work! Now to figure out how to use it on Sunfire... Should be simple...

 

[somarco]

Won't there be an LEP assessment for exceeding 63 days without creditable drug coverage?

 

[sshafran]

Won't there be an LEP assessment for exceeding 63 days without creditable drug coverage?

Probably, yes. But at least they won't have to wait until 1/1/25 effective.

 

[TwoCents]

Spoke too soon. I had looked on Jarvis for SEPs. Just found a WellCare email with a tornado SEP all counties for March 14. Winner winner chicken dinner - that should work! Now to figure out how to use it on Sunfire... Should be simple...

Did he really miss his other elections due to tornados? No. Does he qualify for the disaster SEP? No.

 

[sshafran]

Did he really miss his other elections due to tornados? No. Does he qualify for the disaster SEP? No.

How do you (or I) know he did not? It's conceivably possible that on the day of poor weather he could have gotten more clarification on the matter, as he thought he had an 8-mo period of time, just like for Part B, but he didn't due to a power outage or just not feeling like calling someone for a 2nd opinion.

Prove he didn't, and I'll refrain from writing the app.

 

[TwoCents]

How do you (or I) know he did not? It's conceivably possible that on the day of poor weather he could have gotten more clarification on the matter, as he thought he had an 8-mo period of time, just like for Part B, but he didn't due to a power outage or just not feeling like calling someone for a 2nd opinion.

Prove he didn't, and I'll refrain from writing the app.

You are supposed to ask the client questions to determine the SEP; sounds like you're applying conjecture. Have fun with that.

 

[sshafran]

How do you (or I) know he did not? It's conceivably possible that on the day of poor weather he could have gotten more clarification on the matter, as he thought he had an 8-mo period of time, just like for Part B, but he didn't due to a power outage or just not feeling like calling someone for a 2nd opinion.

Prove he didn't, and I'll refrain from writing the app.

Until you prove the negative (good luck), I'll plan to write his $0 PDP and save him and his wife money now on his Rx's and in the future on a LEP.

 

[sshafran]

I was affected by an emergency or a major disaster (as declared by the Federal Emergency Management Agency, or by Federal, my state, or my local government). One of the other statements on this page applied to me, but I was unable to make my request because of the disaster.

That's the CMS checkbox on Medicare's site.

He was affected as it was declared.

The 2nd part, you have a point. "Unable to make my request because of the disaster" would be a stretch.

But not impossible. I will concede that your caution is warranted.

 

[sshafran]

I have to wonder how many thousands of weather SEPs were really because they missed their appointment due to the wind.