Would She Qualify for SEP for Part D?

[sman]

I just received a call from a lady who has an old Med Supp with BCBS of Georgia. It's called Group 65 High Option w/deductible. We called BCBS to get some details and they couldn't provide a whole lot. The plan includes a prescription benefit. It has a $25 deductible for prescriptions and then reimburses her 80% of the cost.

The question is, if she replaces this supplement with a new supplement, would she qualify for a SEP for Part D? BCBS couldn't answer that question for us. They did say they would send ONE certificate of credible coverage (no stipulation that it includes Rx coverage). So we really don't know if the current Rx coverage is considered credible coverage or not.

 

[AttillaTheOne]

I don't think she could qualify for a SEP UNLESS she is able to qualify for the LIS (low income subsidy program) which you can read about on SSA.GOV In times like these, every dollar counts. Save an average of $3,900. to be specific.

Typically if she has income under $16,000 or so if single, 22,000 or so if married and liquid assets under about 23,000 she might qualify for it and then it creates an SEP for the Part D.

Hope this helps

Geo

 

[jdeasy]

I just received a call from a lady who has an old Med Supp with BCBS of Georgia. It's called Group 65 High Option w/deductible. We called BCBS to get some details and they couldn't provide a whole lot. The plan includes a prescription benefit. It has a $25 deductible for prescriptions and then reimburses her 80% of the cost.

The question is, if she replaces this supplement with a new supplement, would she qualify for a SEP for Part D? BCBS couldn't answer that question for us. They did say they would send ONE certificate of credible coverage (no stipulation that it includes Rx coverage). So we really don't know if the current Rx coverage is considered credible coverage or not.

There are 65 different SEP situations. This might be one. Call Medicare and ask for a part D specialist. With luck, you will get a good one and they can help you with many unknown SEP's. If there is one, ask for the code number and the description, you will need that for the marmadon at whatever Part D carrier you try to place her with if there is an SEP. Or ven better, let Medicare enroll her into a part D.

 

[policy doctor]

That is an old policy!! But if she is taking a lot of meds or costly meds, she may do better staying where she is.

Her premium with the new Part D will be more than her current deductible, plus she doesn't have a donut hole in her present plan. She's prob in her late 70's or 80's to even have this policy. Would a new med supp premium save her that much?

It's getting tricky to move folks around.

 

[sman]

I know you mean well, but trust me, the math works in her favor. Her current premium is $363. The cost of her meds if she had to buy them outright is about $60 per month. So she's paying $363 plus the $12 for her meds, a total of $375 per month.

A new med supp with AARP would be $164.75. The current PDP plan that would best suit her is Advantra Rx Value at $23.50 per month with $32 in copays for meds. That's a total of about $220 per month or $1800+ over 12 months.

You tell me, would a new med supp save her that much.

Nothing tricky about this one other than getting someone at BCBSGA to clarify whether the current Rx coverage is creditable coverage.

That is an old policy!! But if she is taking a lot of meds or costly meds, she may do better staying where she is.

Her premium with the new Part D will be more than her current deductible, plus she doesn't have a donut hole in her present plan. She's prob in her late 70's or 80's to even have this policy. Would a new med supp premium save her that much?

It's getting tricky to move folks around.