Plan Termination or Not!!!

Oct 13, 2015

  1. G.Gordon
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    G.Gordon Guru

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    I have clients on Humanas PPO 1716-020, they did away with this plan for 2016 and merged it with their other PPO 1716-001. If the 020 is no longer available isn't this a plan termination?

    Humana's ANOC to those in that plan just say they will be auto enrolled if they do nothing. No letter about termination or other rights to GI plans.

    I have at least one that would benefit from a medigap, but with no letter, no GI.
     
    G.Gordon, Oct 13, 2015
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  2. Fisher
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    Damn good question, Gordon. I have a client in a similar situation. I'm waiting on a response from Humana.

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    The folks on the old plan are being migrated to the 001 plan so there is no plan termination nor SEP available to them. We migrate people from one plan to another as need be, only when we leave a county and do not move the members to a similar plan does that create a plan exit.

    Frank Noto
    Market Sales Manager | Missouri MarketPoint

    *************************************************

    So there you go. I honestly think that Humana is TRYING to lose market share. In this state anyway. 2016 plan designs are in the toilet.
     
    Fisher, Oct 13, 2015
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  3. ecotainer
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    Would you post the letter your client received. I don't think the MA carrier can involuntarily move someone to another plan. I think your client has the ability to switch plans and should have an SEP for Med Supp. I think the Humana agent is wrong
     
  4. Midlevel
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    The UH MAPD in my area is changing the numbers of the plan but still saying it is the same plan. I was told it's due to Star Ratings being better in certain plans so they merge them? No GI to Med Sup in this case I was told.
     
    Midlevel, Oct 13, 2015
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  5. ecotainer
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  6. G.Gordon
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    That is just it, there is no letter. Just mentioning of it in their ANOC. No clear, "your plan in terminating" or anything close.
     
    G.Gordon, Oct 13, 2015
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  7. TwoCents
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    From Chapter 2 of the Medicare Managed Care Manual Issued by CMS:
    Note: Approved plan consolidations are neither terminations nor non-renewals. Thus individuals affected by plan consolidations are not eligible for the SEP for non-renewals or terminations.
     
    TwoCents, Oct 13, 2015
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  8. MedicareAgent
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    I was told they did a plan number "restructure"
     
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