SEP Question-Need Help!

Jul 17, 2008

  1. insurance0707
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    insurance0707 Guru

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    Hi,

    I have a lead that just came in. It's for a couple that were just dropped from their group coverage 7-1-08. They enrolled in AARP med supp and rx plan with a 7-1-08 issue date. I called him about a Blue Cross MAPD plan. He likes the Blue Cross better and would like to enroll with Blue Cross effective 8-1-08. I know he has a 63 day period (SEP) to enroll into something. Does he just have a onetime SEP or can he change his mind and disenroll from the AARP PDP plan and the med sup to go over to Blue Cross?

    Any help would be appreciated.

    thanks!
     
  2. patch36
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    patch36 Guru

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    It is my understanding that he is stuck with what he has until AEP for a Jan 1 effective date. The only exception might be an SNP MAPD if they have the qualifying condition and if those plans are offered in your state and county. Possibly some cooling off period is in effect in your state that would allow them to cancel and switch, but it is going to be a hassle for the client to cancel his Med Sup and switch to a MAPD effective 8/1.

    I would consider leaving them where they are, stay in touch and rewrite them November 15.
     
    Last edited: Jul 17, 2008
    patch36, Jul 17, 2008
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  3. GreenSky
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    GreenSky Guru

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    I agree with patch. I think they're stuck in their choice until the end of the year.

    By the way, I think patch36 is way smarter than the other 35 patches that used to post.

    Rick
     
    GreenSky, Jul 17, 2008
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  4. AgentBartlett
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    quick question, do you use BCBSM as a main product line or just a backup. Customer service sucks almost as bad as the commission. I only use it when i HAVE to. Just curious if I am missing something on that one.:skeptical:
     
  5. insurance0707
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    When you lose group coverage you have a SEP to enroll in a PDP or MAPD plan within 63 days of losing the coverage. It doesn't matter if you're not in the AEP or OEP. Everything I've read states this. It doesn't state though that once you make one selection within the 63 day period that your now locked in. My hope is that this person is still in his 63 day SEP and can still enroll in the Blue Cross MAPD.

    In regards to BCMI yes they have the lowest commissions out there on MAPD, but the name recognition, low premiums, doctors/hospitals accepting them and the coverage provided more than makes up for it. That said, they are so far behind on paying me, financially I just couldn't keep them as my main company. I had to wait over a half a year for them to pay me my renewals. Unbelievable!!!! I still haven't been fully paid.
     
  6. jdeasy
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    I'm absolutely positive that they can enroll in an MA only plan now with an effective date of Aug 1.

    I'm equally positive that they have only 1 PDP election.

    They have an SEP-Loss EGHP. Code #15 {This allows only 1 election}.

    They could have gone with the MAPD instead of the stand alone PDP. Since they didn't, you have to leave it alone until the AEP.
     
    jdeasy, Jul 17, 2008
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  7. insurance0707
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    insurance0707 Guru

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    It's unfortunate that this program is so new. It's hard to call the insurance carriers and get a correct response. I considered calling but then I thought back to all of the other times I've called and it seemed like I had to educate and explain the SEP's, OEP's AEP's, etc. to the person I spoke with. This is not just one particular insurance company but 3 or 4 different ones.

    I'll call Medicare on this one tomorrow and post back to let you know. Unless anyone has experienced this before and knows about this.
     
  8. insurance0707
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    ahhhh jdeasy, that's not what I wanted to hear....(thanks for the info though) You're probably right but I'll call Medicare tomorrow. It's hard to believe we only have about 3 months before we have to start the certification, training, etc. all over. I don't think my nervous system has recovered from last year's AEP and OEP.
     
  9. patch36
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    patch36 Guru

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    As you state, they have 1 Election, and they exercised it with the Med Sup and PDP effective July 1. I do not think they can make any changes until AEP. Am I reading the rules wrong or missing something ?
     
    Last edited: Jul 17, 2008
    patch36, Jul 17, 2008
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  10. jdeasy
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    They could still do an MA only during the 2 month period from the time they lost their coverage. They had one election for the PDP. They will still have a 6 mo. GI period from the date their part B went into effect if they do chose an MA and decide they don't want it. Of course, they would n't be able to drop the MA until the AEP.

    I've had this exact situation many times. Just dealt with one in the last 2 weeks where the guy took out a med sup and wished he hadn't. It started July 1. He is in an MA now with an effective date of Aug 1. He didn't buy a PDP from the other guy nor did he want one from me, so, we didn't have that issue.
     
    jdeasy, Jul 18, 2008
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