How do you get paid if you write someone new to medicare on a mapd and two months later you rewrite them on a dual plan as a result of qualifying for medicaid. Do you get charged back on the first plan and then get repaid on the second plan. Or do you get charged back completely and start getting renewals the next year?
Plan change commission question
- Thread starter usakr
- Start date
XpressInsurance
Super Genius
- 244
You get screwed. Rapid disenrollment from 1st plan then prorated for dual plan for rest of year. You don't get your 1st year commission, you usually end up with a loss for doing the right thing.
Unless they finished out the calendar year - it's rapid dis-enroll.
If you do get hit with rapid disenrollment, fight for an exception.
Exceptions to the requirement for a Plan/Part D sponsor to recover compensation because of a rapid disenrollment may be granted when CMS determines that recoupment is not in the best interests of the Medicare program. CMS has made that determination for changes in enrollment made for the following reasons: Becoming LIS or dual (Medicare and Medicaid) eligible.
Exceptions to the requirement for a Plan/Part D sponsor to recover compensation because of a rapid disenrollment may be granted when CMS determines that recoupment is not in the best interests of the Medicare program. CMS has made that determination for changes in enrollment made for the following reasons: Becoming LIS or dual (Medicare and Medicaid) eligible.
^ Awesome!
- 2,177
A plan change within first three months due to beneficiary becoming eligible for Medicaid is one of the exceptions to rapid disentollment rules whether or not they change at end of plan year.
- Thread starter
- #7
That makes sense. Why do the insurance companies not abide by this? Doesn't cms enforce this? Where can I find this specific info to make my case?
CMS Marketing Guidelines pg 56 Medicare Marketing Guidelines - Centers for Medicare & Medicaid Services
- Thread starter
- #9
Cool. Thanks
