PDP ?

[toc3]

I have an 87 yo lady whom has never had a stand alone PDP or an MAPD. In my mind I thought that if she elected to enroll into a PDP that she would be penalized 1% for each month she was eligible but did not enroll. I just hung up with Coventry and was told that she would not be penalized because she had never had one. The rep told me that the penalty is only if someone drops a plan and then go's without one that a penalty woud occur. What do you veterans say?

 

[wilkin]

I think you should talk to another Coventry person because the first one gave you wrong information. She is subject to the penalty.

 

[retread]

I have an 87 yo lady whom has never had a stand alone PDP or an MAPD. In my mind I thought that if she elected to enroll into a PDP that she would be penalized 1% for each month she was eligible but did not enroll. I just hung up with Coventry and was told that she would not be penalized because she had never had one. The rep told me that the penalty is only if someone drops a plan and then go's without one that a penalty woud occur. What do you veterans say?

The Coventry CSRs are not agents, they only know the plan info. This is a good example why agents are necessary. The lady IS subject to the 1% penalty/mo. She will be penalized for every month since May '06 through Dec '08 that she did not have "creditable" prescription insurance. This is tracked by CMS and will be demanded from whoever she contracts with for a PDP for the rest of her life. The only good news is that as of this year it is only about 30 cents per month. That comes to about $9.30. I would caution her that this is only an estimate, and that she should get the final rule from CMS after she submits her ap, assuming she does so this AEP. If she doesn't sign up by Dec 31st this year, she will add another $3.60/mo to that amount for each year she delays. There is only ONE time each year she can join a PDP, and that's Nov 15th to Dec 31 (unless she is on Medicaid).

 

[toc3]

The Coventry CSRs are not agents, they only know the plan info. This is a good example why agents are necessary. The lady IS subject to the 1% penalty/mo. She will be penalized for every month since May '06 through Dec '08 that she did not have "creditable" prescription insurance. This is tracked by CMS and will be demanded from whoever she contracts with for a PDP for the rest of her life. The only good news is that as of this year it is only about 30 cents per month. That comes to about $9.30. I would caution her that this is only an estimate, and that she should get the final rule from CMS after she submits her ap, assuming she does so this AEP. If she doesn't sign up by Dec 31st this year, she will add another $3.60/mo to that amount for each year she delays. There is only ONE time each year she can join a PDP, and that's Nov 15th to Dec 31 (unless she is on Medicaid).

That is what I thought Retread. Thanks. How did you come to $9.30? 12 month penalty for '08, 12 month penalty for '07 and 8 month penalty for '06 if we count may comes to 32 months. So would it be 32% of the monthly premium added? Help. I know that I don't configure it in to the premium and that CMS does this, but I would like to be able to tell her what to expect.

 

[retread]

That is what I thought Retread. Thanks. How did you come to $9.30? 12 month penalty for '08, 12 month penalty for '07 and 8 month penalty for '06 if we count may comes to 32 months. So would it be 32% of the monthly premium added? Help. I know that I don't configure it in to the premium and that CMS does this, but I would like to be able to tell her what to expect.

7 months for '06, 24 for '07 and '08=31. 31 x .30=9.30
(look in the back of the Medicare & You 2009 page 127, and you will find the penalty is $.30 per month.)

Starting in '06, she had until May to enroll, leaving 7 months for the remainder of the year.

For '07 it is 12 months... Duh!

Since she won't be on a PDP until 1/1/09 at the earliest, assuming she signs up this AEP, she will be penalized for the full 12 months of '08.

7 + 12 + 12= 31

 

[MedSuppPro]

I have a vet that I have been trying to convince to apply for level 8 VA benefits. He has now decided to apply for Part D for the first time. He's not sure about VA.

I know VA is "creditable" prescription insurance. What happens if he applies and gets VA benefits after his PDP goes into force January 1st. He will then get nailed with the 9.3 buck penalty. But, will Medicare reverse his penalty after he gets VA benefits after the fact? Anyone know the answer?

Help a vet!

 

[Joe Moore]

I have a vet that I have been trying to convince to apply for level 8 VA benefits. He has now decided to apply for Part D for the first time. He's not sure about VA.

I know VA is "creditable" prescription insurance. What happens if he applies and gets VA benefits after his PDP goes into force January 1st. He will then get nailed with the 9.3 buck penalty. But, will Medicare reverse his penalty after he gets VA benefits after the fact? Anyone know the answer?

Help a vet!

I really do not see how they would make the reversal. He has not had "creditable coverage" in the past. I would think he would be subject to the penalty.

 

[retread]

I have a vet that I have been trying to convince to apply for level 8 VA benefits. He has now decided to apply for Part D for the first time. He's not sure about VA.

I know VA is "creditable" prescription insurance. What happens if he applies and gets VA benefits after his PDP goes into force January 1st. He will then get nailed with the 9.3 buck penalty. But, will Medicare reverse his penalty after he gets VA benefits after the fact? Anyone know the answer?

Help a vet!

I didn't think a vet HAD to have level 8 to get Rx, just medical. Are you sure about this? I was under the impression that to get VA Rx, you just went to the VA hospital and filled out some paperwork. Does this paperwork involve enrolling in VA medical benefits? I know a number of vets that get Rx, but not medical. Enquiring minds want to know.

I thought level 8 was cutoff at the present time....