Would You Write Today's Options MAPD on your 92 Yr Old Grandmother?

[JustinTime]

Dear insureitnow,

Unfortunately, there have been a ton of Medicare Advantage PFFS problems that we've dealt with at our company. Sometimes, it's CMS' fault and sometimes the company has made an error. However, I've had a couple of personal experiences recently where people have gotten kicked out of their PFFS or Part D plans.

My recommendation is to get your grandmother back into a Medicare Supplement if possible. If you check out page 19 of the 2008 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare and look at Situation #5 you might be able to get her reinstated into a Medicare Supplement if she qualifies for this. Some Medicare Supplement companies will allow you to enroll into their plan with this above situation even if you didn't have their Medicare Supplement plan before they enrolled into a PFFS plan. While I'm not for sure if another Med Supp company besides Anthem will accept her I've heard of other companies like Mutual of Omaha/United World/United of Omaha accepting people like this. You might want to try calling them up at 800-673-6493 and see if this will work.

If your grandma can afford a Medicare Supplement I would try getting her into one. This would be her best bet (in my opinion) to have reliable coverage. That way you won't have to guess of whether or not the hospital or doctor will accept the Today's Options PFFS plan.

 

[retread]

Something sounds fishy with this situation. If you submitted an application with a MAPD that was to replace an MAPD during the OEP, then the replacement MAPD will automatically kick out the former, once entered into the system. This is not so with Med Sups. To replace an MAPD with a Med Sup, the client MUST WRITE a letter of disenrollment request to the MAO, and sign a "replacement notification" to the Med Sup. In this case, if TO failed to submit the ap properly to CMS, then that's their problem and they are at fault, and should be required to cover her.

What experience tells me, is that often seniors well advanced in age will muddy the waters by making phone calls in your absence and forgetting they did so, or just won't tell you. In the meantime, if that call is made to the 1-800-Medicare number, it will bring havoc into the scene.

 

[JustinTime]

Dear insureitnow,

You sent a PM that asked:

"You have a phone number I could call? I have a question about MOO plan for my 92 year old grandmother."

I don't have 20 posts yet...so I have to post this up on the Forum...


Mutual of Omaha's broker number is 800-673-6493.

Also, I work for a FMO called Senior Marketing Specialists: Senior Marketing Specialists.

User ID: SMS
Password: 1234

We work exclusively in the senior life and health insurance market and have approximately 5,000 agents/agencies that go through us. The only reason I bring that up is that we work heavily in the Medicare Supplement market and are licensed in Florida. One of the main companies I recommend is Sterling Investors. They have competive rates which you can view by clicking the link below.

Florida Sterling Rates 04-01-08

If you would be interested in knowing more or getting licensed please feel free to call me, Ryan Reddick, at 800-689-2800 ext. 305 or by e-mail at [email protected]. We're getting ready to leave for the weekend, but will be back open Monday from 9am-5pm CST. Hopefully the above information helps you out and I hope to hear from you soon.

 

[samantha129]

Just stick with it insureitnow. Sad to say, but I had one that took almost 6+ months to straighten out. The client was a SERS retiree paying way too much money and wanted to move over to MA-PD. In fact, it was a MA-PD plan through Anthem and as the old story goes Anthem says its CMS and CMS says its Anthem fault.

It sounds as though she may be on a group plan as I stated above it happened to a couple of my clients Some how CMS knew about it and said they weren't allowed to make the move to MA-PD because they already had coverage in force.

By the way, I don't know what state your in and if you can't get this straightened out I'd only write her United of Omaha for the short term only if your looking to get her back on the MA-PD in the Fall, because Mutual of Omaha opens a book of business for 3 or so years and then shuts it down when the premiums aren't competitive anymore and they then start a new book of business. United World started in 2005 and is shutting down and now you have United of Omaha which has low rates and low commissions to boot! I personally think this is not right to their insureds, nor the Agents who try to find the right company the first time for their clients.

 

[GreenSky]

The answer to why she was rejected was that she did not have a PDP in place when the MAPD was written.

Rick

 

[Mr. Bill]

This is absolutely disgusting - to place this kind of stress on seniors is an unimaginable horror. Yet of course, who's to blame? The agents:

States Look to Rein In Private Medicare Plans - New York Times

And who represents US?

 

[GreenSky]

This is absolutely disgusting - to place this kind of stress on seniors is an unimaginable horror. Yet of course, who's to blame? The agents:

States Look to Rein In Private Medicare Plans - New York Times

And who represents US?

CMS and Congress is to blame when they set up "lock in."

Rick

 

[samantha129]

Don't kid yourself, the insurance companies wanted lock-in as well.

Personally, I feel they need to move AEP to the Medicare beneficiaries birth month. Reason being, what happens between 11/15 and 12/31 each year...Thanksgiving and Christmas! If they moved it to the birth month the Medicare beneficiaries wouldn't be bombarded around this time of year and the insurance companies and CMS would be able to keep up with the processing demands, etc. I'd like to know who the individual was at CMS that thought it was a good idea to have 42 million people trying to figure what to do and make a move in 45 days!

I'd also like to see them give the beneficiaries one free pass that would allow them to make one move during the lock-in period.

 

[GreenSky]

Don't kid yourself, the insurance companies wanted lock-in as well.

Personally, I feel they need to move AEP to the Medicare beneficiaries birth month. Reason being, what happens between 11/15 and 12/31 each year...Thanksgiving and Christmas! If they moved it to the birth month the Medicare beneficiaries wouldn't be bombarded around this time of year and the insurance companies and CMS would be able to keep up with the processing demands, etc. I'd like to know who the individual was at CMS that thought it was a good idea to have 42 million people trying to figure what to do and make a move in 45 days!

I'd also like to see them give the beneficiaries one free pass that would allow them to make one move during the lock-in period.

You are correct that the carriers like lock-in. I like the AEP birth month idea also.

The bottom line is that neither the carriers nor CMS really have the beneficiaries needs in mind.

Rick

 

[midwestbroker]

There are 2 sides to the carriers and the lock in

1. The carriers get to keep people on the books.

2. The carriers cannot gain more people / cuts their enrollment times

What used to happen prior to all this, the carriers would release their plans, then about mid year they could make mid year improvements to be more competitive. Seniors had all year to choose plans. They had mid year to check improvements and see if one was now better then the other.

I know that Humana did not want the lock in. They fought against it.

What the lock in has created is the SNP to come out. This gives the carriers something to market during the rest of the year.