Wellcare PDP LEP letter

[TwoCents]

You're half right. The 2025 update to the creditable coverage guidance made it so plans have to wait until CMS approves the enrollment before the attestation request letter can be sent out. Obviously, in this case that time has come and gone a while ago.

But also you're half right in a different way. Plans would submit the enrollment reporting no gap, but if there was a possible gap then the attestation request goes out. If a response is received that accounts for all months then it stays at no gap. But say the plan figured 12 months with no prior CC and no response is received then that 12 months is what the LEP will be based on.

 

[Special Agent]

You're half right. The 2025 update to the creditable coverage guidance made it so plans have to wait until CMS approves the enrollment before the attestation request letter can be sent out. Obviously, in this case that time has come and gone a while ago.

But also you're half right in a different way. Plans would submit the enrollment reporting no gap, but if there was a possible gap then the attestation request goes out. If a response is received that accounts for all months then it stays at no gap. But say the plan figured 12 months with no prior CC and no response is received then that 12 months is what the LEP will be based on.

Ok so this client said he had the same employer insurance forever so this no lep letter scenario happens when the the most recent creditable coverage is the only rx coverage a consumer has had going back to to at least when they turned 65 or could it still be a hit or miss even then?

 

[TwoCents]

Ok so this client said he had the same employer insurance forever so this no lep letter scenario happens when the the most recent creditable coverage is the only rx coverage a consumer has had going back to to at least when they turned 65 or could it still be a hit or miss even then?

Right.

Going back to the client info:
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.

You don't say when Part A started in 2021 so let's just say March 1.

Assuming this is a situation involving the RDS, CMS would have record of it from March 1, 2021, up to December 31, 2024. Then Wellcare starts 1/1/25. Wellcare checks Medicare records sees the RDS for all that time. Since the client had that RDS status all the way from his IEP in 2021 up to enrolling into a Part D plan then there is no gap in creditable coverage.

I really would like to see the client's info on MARx.