Wellcare PDP LEP letter

anybody familiar with wellcare's pdp LEP letter.I have a client who enrolled in wellcare pdp 1/1/25 as his first pdp enrollment.he had part A since 2021 and was covered under group coverage since then.he never got the LEP letter from wellcare and when he called wellcare he was told he has no LEP because he had a 0 premium plan .I said this was wrong and he called back and another wellcare rep said no letter sent -no worries.I told client to call medicare to make sure.Has something changed about the prior coverage attestation process or is just a wellcare screw up?
 
anybody familiar with wellcare's pdp LEP letter.I have a client who enrolled in wellcare pdp 1/1/25 as his first pdp enrollment.he had part A since 2021 and was covered under group coverage since then.he never got the LEP letter from wellcare and when he called wellcare he was told he has no LEP because he had a 0 premium plan .I said this was wrong and he called back and another wellcare rep said no letter sent -no worries.I told client to call medicare to make sure.Has something changed about the prior coverage attestation process or is just a wellcare screw up?
As you know, i am not an agent.

I think you (or your client) are going to have a very difficult time forcing wellcare to do something they do not want to do.

I think the best you can do is to advise your client to keep his evidence to prove the time period of group coverage and its creditability for Medicare purposes accessible for a future year when and if a different carrier or a premium plan causes the PDP carrier to request that information.
 
As you know, i am not an agent.

I think you (or your client) are going to have a very difficult time forcing wellcare to do something they do not want to do.

I think the best you can do is to advise your client to keep his evidence to prove the time period of group coverage and its creditability for Medicare purposes accessible for a future year when and if a different carrier or a premium plan causes the PDP carrier to request that information.

hopefully he wont get a letter after it's too late.
 
It is possible that his employer was receiving a retiree drug subsidy from CMS. CMS would keep track of this info and that time would not been seen by Wellcare as a gap in creditable coverage. Someone with MARx access could confirm this.
 
It is possible that his employer was receiving a retiree drug subsidy from CMS. CMS would keep track of this info and that time would not been seen by Wellcare as a gap in creditable coverage. Someone with MARx access could confirm this.
does this mean he may have had part d with through his employer coverage.?my understanding is that all large employer groups get some type of subsidies for medicare eligible workers on their group coverage but still have to attest to it after the fact but hey you learn something new everyday
 
does this mean he may have had part d with through his employer coverage.?my understanding is that all large employer groups get some type of subsidies for medicare eligible workers on their group coverage but still have to attest to it after the fact but hey you learn something new everyday

No, the drug plan offered by an employer receiving the retiree drug subsidy (RDS) from CMS shouldn't be Part D, but has to be creditable. Assuming the RDS was active from 2021 to Dec 2024, Wellcare would have ran an eligibility check against MARx and got those RDS dates. The CMS guidance about the LEP tells them that the creditable coverage count should begin on "the last day the person had RDS coverage" assuming that was the most recent coverage.

RDS is also the reason a client will sometimes get a letter from a plan basically saying "are you sure you want to join? this could interfere with other drug coverage you may have." If the RDS isn't turned off at the time the Part D enrollment is processed, then the plan has to confirm that the client wants to proceed with the enrollment.
 
No, the drug plan offered by an employer receiving the retiree drug subsidy (RDS) from CMS shouldn't be Part D, but has to be creditable. Assuming the RDS was active from 2021 to Dec 2024, Wellcare would have ran an eligibility check against MARx and got those RDS dates. The CMS guidance about the LEP tells them that the creditable coverage count should begin on "the last day the person had RDS coverage" assuming that was the most recent coverage.

RDS is also the reason a client will sometimes get a letter from a plan basically saying "are you sure you want to join? this could interfere with other drug coverage you may have." If the RDS isn't turned off at the time the Part D enrollment is processed, then the plan has to confirm that the client wants to proceed with the enrollment.

.So tell working eligible clients taking part D for the first time that they may or may not get a letter about LEP? Wow i have been doing this for a long time and just learned this today.I was aware of the " are you sure you want to join " letter however. Thanks
 
It is possible that his employer was receiving a retiree drug subsidy from CMS. CMS would keep track of this info and that time would not been seen by Wellcare as a gap in creditable coverage. Someone with MARx access could confirm this.

No, the drug plan offered by an employer receiving the retiree drug subsidy (RDS) from CMS shouldn't be Part D, but has to be creditable. Assuming the RDS was active from 2021 to Dec 2024, Wellcare would have ran an eligibility check against MARx and got those RDS dates. The CMS guidance about the LEP tells them that the creditable coverage count should begin on "the last day the person had RDS coverage" assuming that was the most recent coverage.

RDS is also the reason a client will sometimes get a letter from a plan basically saying "are you sure you want to join? this could interfere with other drug coverage you may have." If the RDS isn't turned off at the time the Part D enrollment is processed, then the plan has to confirm that the client wants to proceed with the enrollment.

As usual, thank you for the education you share on stuff like this.

My only concern with this is it is a highly sophisticated and tecnical reason there might not be an LEP which does not square well with what OP said his client was told by Wellcare.

anybody familiar with wellcare's pdp LEP letter.I have a client who enrolled in wellcare pdp 1/1/25 as his first pdp enrollment.he had part A since 2021 and was covered under group coverage since then.he never got the LEP letter from wellcare and when he called wellcare he was told he has no LEP because he had a 0 premium plan .I said this was wrong and he called back and another wellcare rep said no letter sent -no worries.I told client to call medicare to make sure.Has something changed about the prior coverage attestation process or is just a wellcare screw up?

The PDP policy holder is being told no coverage attestation is necessary because of the $0 premium nature of the PDP rather than WellCare having employer coverage information on file from other sources.

This leaves me feeling like OP's client is not free of the possibility of a request for coverage verification in another future PDP year.
 
It's a call center; even the best and brightest aren't going to be trained on everything, but I wish they didn't ad lib and talk BS like that $0 premium thing. But OP already nipped that in the bud with the client.

The timing as to when Wellcare has to report a gap in creditable coverage that results in a LEP is highly monitored by CMS and is spelled out in Chapter 4 of the drug manual [EXTERNAL LINK] - Creditable Coverage and Late Enrollment Penalty | CMS.

Wellcare can't just send out a letter asking for prior coverage info whenever they feel like it.
 
As usual, thank you for the education you share on stuff like this.

My only concern with this is it is a highly sophisticated and tecnical reason there might not be an LEP which does not square well with what OP said his client was told by Wellcare.



The PDP policy holder is being told no coverage attestation is necessary because of the $0 premium nature of the PDP rather than WellCare having employer coverage information on file from other sources.

This leaves me feeling like OP's client is not free of the possibility of a request for coverage verification in another future PDP year.

that was the first call clint made to the wellcare philippine islands call center the next call they told the client no penalty and no letter

client submitted application for welllcare aprox 12/20/24 and got the plan approval statement (that i saw )that said 0 premium 0 LEP on 12/28/24 .I thought the prior coverage attestation always happened after the fact via the LEP Letter that is mailed after application is approved.This client worked for mega corp so i am wondering this have anything to do with the size of the eghp?
 
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