PDP in Combination with MA PPO?

[Slade]

I just received a very confusing email from a major carrier. It states the following:

"Please be advised that CMS will not permit the combination of a stand alone PDP with any other MA plan other than a PFFS plan that does not have Rx."

"Stand alone PDP can be sold by itself or in combination with a Med Supp or PFFS-no Rx plan but can not be sold with a PPO - no Rx plan."

That was not my understanding. I have tried to find some reference for this but can't find any. In fact, the Medicare and You handbook says the exact opposite. The Medicare web site will also allow enrollment in a stand alone PDP when you have a MA PPO - no Rx plan.

Is the information in this email accurate?

 

[retread]

If I am not mistaken, the CMS rule is that no "MA Only" plan can be paired with a Stand-alone PDP. This was to stop agents from stripping the Part D from their MAPDs and selling a MA + PDP to increase their commission.

 

[Slade]

According to the email, you can sell a PDP along with a MA only PFFS, but not a MA only PPO. If that is indeed the case, who would ever enroll in a MA only PPO?

 

[retread]

According to the email, you can sell a PDP along with a MA only PFFS, but not a MA only PPO. If that is indeed the case, who would ever enroll in a MA only PPO?

Vets, for one. VA pharmacy benefits are "creditable" coverage, incurring no penalty, so if they change their mind at a later date and sign up for a PDP, they won't have the LEP applied. Same goes for other exempt Rx plans.

In the case of others: The mistake some headstrong but healthy seniors is that since they don't take any Rx, they don't want a PDP. That's fine until they eventually get sick and need some expensive drugs. Sometimes you just can't convince them of what "insurance" means.

 

[Slade]

True, I forgot about the vets. It still makes no sense to deny a stand alone PDP to MA only PPO enrollees since the MAPD RX coverage may be inferior to an available PDP.

If a Medicare beneficiary enrolls online through Medicare.gov the MA only PPO and PDP combination is available to them. It amazes me that a client has more options without an agent than with one.

 

[jdeasy]

I just received a very confusing email from a major carrier. It states the following:

"Please be advised that CMS will not permit the combination of a stand alone PDP with any other MA plan other than a PFFS plan that does not have Rx."

"Stand alone PDP can be sold by itself or in combination with a Med Supp or PFFS-no Rx plan but can not be sold with a PPO - no Rx plan."

That was not my understanding. I have tried to find some reference for this but can't find any. In fact, the Medicare and You handbook says the exact opposite. The Medicare web site will also allow enrollment in a stand alone PDP when you have a MA PPO - no Rx plan.

Is the information in this email accurate?

There are some PPO and HMO plans allowed by CMS that do not have the PDP included. All PPO/HMO plans are supposed to have RX included with there few exceptions. The one that are excepted CANNOT have a PDP in conjuntion with the plan.

This can be a good plan for people that use the VA or people that have RX coverage thru their spouse's employer plan or for people that just do not want a PDP plan. In my area, Humana has a non RX PPO that has much better benefits than their other PPO plans. There is also a regional HMO here that has a $0 premium HMO without RX that is better than their other plans.


There are not a lot of seniors that do not need or want a PDP, but, there are some.

 

[Cenla Agent]

Writing a PDP in combination with a MA only PPO is a good way to end up with a Section A violation.

MA only PFFS plans can however be coupled with stand alone PDP's.

As noted above, the HMO and PPO plans without Rx coverage are primarily designed for VA beneficiaries (who already have creditable Rx coverage) who may want an alternative to the VA and want better coverage than Original Medicare.

 

[retread]

Exactly

Yes

That's what I think was being said

..... dept of reduncy dept

 

[JaBrooklyn]

Meeting up Saturday, client appears to have a union PDP only...Could they do a combination with an MA only since it wouldn't be considered a part D?

 

[Chazm]

Meeting up Saturday, client appears to have a union PDP only...Could they do a combination with an MA only since it wouldn't be considered a part D?

If it’s considered part D coverage I would think no