SEP Question

Oct 22, 2007

  1. insurance0707
    Offline

    insurance0707 Guru

    Posts:
    1,230
    Likes Received:
    3
    I've come across a couple that is losing their group coverage. They don't have prescription coverage with the group plan, they had to take a Part D prescription plan out. Would this couple qualify for an SEP and be able to enroll in a MAPD with a November 1st issue date? Or would they have had to have group health and prescription coverage to qualify for an SEP for a MAPD.

    Any replys would be helpful.

    Thanks!
     
  2. MedSuppPro
    Offline

    MedSuppPro Guru

    Posts:
    1,214
    Likes Received:
    0
    My guess is that most carriers are going to require prescription credible coverage proof.
     
  3. retread
    Offline

    retread Guru

    Posts:
    1,932
    Likes Received:
    7
    State:
    Kansas
    It is not credible coverage, it is creditable. Big difference!:GEEK:

    The point is, that they did not have any prescription drug coverage, if I understand it correctly. That is not really what gives them their SEP rights. It is the fact that they have lost their group coverage. Since that qualifies them for a SEP, they can get whatever plan they want. Obviously, they would benefit from picking one with drug coverage as part of the benefits. It seems, though, that they have already enrolled in a stand-alone PDP. If they have used their entitlement for the SEP by doing this, they must wait for the AEP to change the current plan.
     
    Last edited: Oct 22, 2007
    retread, Oct 22, 2007
    #3
  4. insurance0707
    Offline

    insurance0707 Guru

    Posts:
    1,230
    Likes Received:
    3
    They took out the part D prescription plan when it first became available 1-1-06 because their group coverage didn't offer prescription coverage. They are losing their group health not the stand alone rx plan.
     
  5. retread
    Offline

    retread Guru

    Posts:
    1,932
    Likes Received:
    7
    State:
    Kansas
    I don't think it matters.... if they lost their group health, and qualified on Medicare, they are in an SEP. If they are in an SEP, all plans are available to them. Sign them up for a MA-PD, and this will automatically disenroll them from the former PDP, and all is well.:)
     
    retread, Oct 23, 2007
    #5
  6. insurance0707
    Offline

    insurance0707 Guru

    Posts:
    1,230
    Likes Received:
    3
    Thanks retread! I thought that was the case.
     
Loading...