I just went to switch a client from an MA plan back to a med supp per her request. I found out that she has cataract surgery scheduled in January. Once she has the surgery, can I switch her from the MA to a med supp at that point or is she stuck for another year with the MA (PFFS)?
Replacing MA with Med Supp After Jan 1st
- Thread starter Todd King
- Start date
- 19,647
Anytime during OEP, she can return to original medicare. She could then buy a med sup.
- 1,240
she can also enroll in a PDP along with the Med supp if the plan she has is an MAPD plan
Not just "can", but "must"! For a bene with a MAPD leaving the AEP and going into the OEP, once in the OEP, the bene cannot drop a PDP, so if they decide to go with Original Medicare (OM), they MUST enroll in a stand-alone PDP. This simply continues the Part D benefits.... the point is: Outside the AEP one cannot pick up or drop prescription drug coverage. So if he/she had Part D benefits coming into the OEP, he/she must exit the OEP with Part D benefits.
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What is she trying to do? get around paying the PFFS outpatient copay? All MA plans must cover cataract surgery available under OM. If the PFFS plan has onerous outpatient co-pays, she may be better off staying with OM once the switch is made. If someone has cataract surgery in one eye, they more than likely will need it in the other. If both eyes can be done in the same month, so much the better, but if it were me, I would wait at least a month or two post surgery until switching back to the PFFS so she won't be hit with another outpatient procedure if she incurs one due to complications. What you should do is calculate the cost of the Med Sup for those few months against the outpatient co-pay. She may find it will cost less to remain with the PFFS. Take the time to do the math.
The only other issue I can think of is the choice of doctor... if the doctor she wants to use doesn't accept the PFFS plan then in my opinion she would be better off staying with OM, since she needs to have him available for post-surgery followup.
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I am confused; what exactly are you asking? Did you physically change her plan?
If so, has she been approved yet?
If you did, did she/you elect a pdp?
If so, has she been approved yet?
If you did, did she/you elect a pdp?
- Thread starter
- #6
ok, guys....thanks for all the answers. I tried to keep this simple. She just wants back on a med supp where she feels more comfortable with NO copays.
She has already had on cateract removed and was scheduled for the other in Oct. However, her husband passed away and she had to reschedule it. I couldn't switch her from the PFFS to a Med Supp because of the scheduled surgery. She would like for me to move her to the Med Supp after the surgery if it is possible. I thought it was possible to do this, but just wanted to make sure.
No, she is NOT on an MAPD.
She has already had on cateract removed and was scheduled for the other in Oct. However, her husband passed away and she had to reschedule it. I couldn't switch her from the PFFS to a Med Supp because of the scheduled surgery. She would like for me to move her to the Med Supp after the surgery if it is possible. I thought it was possible to do this, but just wanted to make sure.
No, she is NOT on an MAPD.
If she does not have a Prescription drug plan at this time, you know, of course, that she will not be able to get one after 12/31 until next year.... time is running short. I have a concern for why she apparently has an MA only plan.... If she doesn't sign up for a PDP, she will face a penalty of $3.60 per year on top of what she may already have accrued to date.... for the rest of her life! The sooner she bites the bullet and enrolls in a PDP, the better for her. The older she gets, the more susceptible she will be for prescription needs and the higher the penalty that will be added on top of her PDP premium.
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- Thread starter
- #8
guys, please stop assuming things. I did say PFFS in my original post. I didn't mention anything about a drug plan because i've had her on a Coventry PDP for a few years now. She's set with that. This situation is the very reason why I NEVER couple an MA and PDP together into one plan. One of the plans may still fit the client needs while the other does not. Nope, have never sold an MAPD and never will. I have plenty of MA plans and plenty of PDP plans, but never and MAPD.
NEVER a MAPD? I don't see how you can paint with such a broad brush. I can see selling an MA with a stand-alone PDP in some special situations, but usually it is less costly for the client to take the MAPD plan, especially with Coventry products. Coventry's AdvantraRx Formulary is hard to beat.
I don't know what PFFS product you are pairing with AdvantraRx, but of all the PFFS products I carry, Coventry's ranks among the top in most counties in my area, along with Secure Horizons... although they (SH) are losing their grip because UHC is dropping some favored hospitals. Once Today's Options drops about 50 options to where they are not so overwhelming, they may gain some ground. Only a few of their products are worthwhile anyway.
You do your thing, though... It's your business. However I would caution others who may view this thread not to follow suit with the sales strategy you advocate. "Never say Never" LOL!
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She could even go back after OEP if this is her first time in an MA, couln't she?
Winter
