PDP Trial Right

[somarco]

Lady called . . . has/had Medicare + Medicaid + Medigap + PDP. Agent called (unsolicited) and sold her an MAPD. Daughter has POA and was not informed of the transaction until AFTER the MAPD was issued. Daughter called PDP carrier and was told they could write a new PDP effective 5/1 under the Trial Right provisions.

While I am familiar with Trial Right for Medicare and Medigap, have not encountered this for PDP.

Medigap has not been cancelled and premiums are current. At this point, Medigap carrier is unaware any of this is going on.

Daughter wants to keep the "old" Medigap and PDP.

This is way beyond my pay grade.

Appears soliciting agent violated Medicare marketing rules. Mom does not have the legal capacity to sign an application. Is there a 10/30 day "free look" for MAPD? If agent committed fraud, can Medicare "unwind" this transaction and make everything whole again?

 

[DonP]

I’m assuming the mapd was just written with an effective date of 5/1? Have the daughter call the new mapd carrier or Medicare and withdraw the mapd app . The current pdp should be current until 4/30 . When you cancel the mapd app the pdp should stay active.When you write a mapd it auto cancels the pdp plan at the end of the month as the mapd takes over .

 

[vic120]

I always put Trial right SEP Trial period on app

UHC states SEP-Indiv drop Medigap-Trial period

The thing about calling MA to cancel, I had one time the MA canceled but so did the PDP

This was a long time ago maybe 8 years, But I don't take chances on it anymore I write the PDP to make sure it works right

 

[goillini52]

Lady called . . . has/had Medicare + Medicaid + Medigap + PDP. Agent called (unsolicited) and sold her an MAPD. Daughter has POA and was not informed of the transaction until AFTER the MAPD was issued. Daughter called PDP carrier and was told they could write a new PDP effective 5/1 under the Trial Right provisions.

While I am familiar with Trial Right for Medicare and Medigap, have not encountered this for PDP.

Medigap has not been cancelled and premiums are current. At this point, Medigap carrier is unaware any of this is going on.

Daughter wants to keep the "old" Medigap and PDP.

This is way beyond my pay grade.

Appears soliciting agent violated Medicare marketing rules. Mom does not have the legal capacity to sign an application. Is there a 10/30 day "free look" for MAPD? If agent committed fraud, can Medicare "unwind" this transaction and make everything whole again?

If she just switched to the MAPD, she can switch back using her trial right period. If she takes a new PDP(eligibility option #24 with Wellcare), it'll cancel her MAPD and her Med Supp is still in place.

 

[axeman462]

worst case scenario, she can appeal to Medicare, have everything reversed because it was done illegally. I had a similar scenario about 7 years ago. The appeal to Medicare took about 2 months. Client is still a customer today (I believe because of it)

 

[somarco]

I have only done 1 Trial Right app . . . 12 years ago . . . one of my first clients . . . the carrier was so grateful they paid me a $25 GI finders fee for placing the business. That was the first, and last, time I wrote a Medigap under a Trial Right.

This is not my client, just trying to help out a lady from another state. There is no $$ in this for me, I just want to help the lady out of a jamb. The writing agent took advantage of the mom and, I presume, since she was a dual, he could change her at any time, or at the beginning of a new quarter (MAPD effective 4/1/2022).

David, thanks for confirming a complaint to Medicare would reset everything. I figured the action would not be swift, but I did suggest this to the mom (reporting the fraud). Her mom is not in a position to wait months due to failing health.

When daughter called the PDP carrier they agreed to write a new policy under the Trial Right provisions. I know enrolling in a PDP disenrolls the person from the MAPD, just never considered writing the PDP before knowing they could go back to Medigap. In this case, at least as of today, the Medigap is still in force (and so is the MAPD). Daughter is hoping to get the MAPD cancelled and the Medigap carrier will never know she had MAPD and Medigap at the same time . . . but there is the issue of April claims.

Nothing major at this point but still have 2 weeks to go . . .

I encouraged the daughter to report the fraud to Medicare since, at this point, mom has Medicare, Medicaid, Medigap and MAPD plus Extra Help.

Could it possibly be any more complicated?

I don't think she can rock along and tiptoe through April without snagging a tripwire. That is why I feel strongly about getting Medicare involved even if they have to protect the mom after the fact.

I also feel the MAPD carrier should be notified about what the agent did . . . cold calling a prospect and writing an app without the knowledge of the POA daughter.

What a mess!

 

[Brande]

I just dealt with a situation like this.
This client was referred to me on March 28th, 2022. He had his Part A, Part B, drug plan, and was SLMB. He had just been diagnosed with cancer. Instead of taking the sale for myself, I sent him to my competition, because there is a regional hospital system in my area that offers their own Medicare Select supplements, and has decided to open their plan G up for the rest of the year - no underwriting. And, it is significantly cheaper than normal supplements. (I wish I could sell this thing, but they only let their own captive agents sell it.) I have sent them a lot of people at this point because there are situations where it is the best thing for the client. So, I sent him there, he met with their agent the next day, March 29th and she was able to get him a 03/30/2022 start date.
BUT, we just found out on Friday ( 04/08/2022) that earlier in the month, client had spoken with a telemarketer about Aetna MAPD. Turns out, the telemarketer had signed the client up for a 4-1-2022 start, without the client realizing it.
This client has a very hard time understanding insurance, but is adamant that he never gave permission to sign up for the Aetna MAPD. He said he was just wanting information on it. I called Aetna multiple times asking for the enrollment to be rescinded. They said no. We called Medicare to see if there was any way to rescind the enrollment and their answer was yes: with a formal complaint against the agent, and an investigation. The client responded that that was what he wanted to do. From that point forward, I stayed out of the way on the phone call because I didn't want to influence the process at all, so I was a fly on the wall listening to the Medicare representative go through the process with the client. According to the rep (who identified as a Tier 2 specialist), the investigation will take about 30 days. If it goes in the client's favor, the MAPD will be removed and his old drug plan put back in it's spot. The Medicare rep also took an enrollment from the client over the phone for his old PDP for a 5/01/2022 start, in case the investigation concludes that there was not a marketing misrepresentation, that way he would at least be back on his old PDP come May 1. (I think she used LIS-Maintaining for that one.)

The problem is the supplement cannot pay after the MAPD, so the only way to get the supplement coverage for the month of April is for Medicare to overturn the MAPD enrollment. Otherwise, even with the supplement hanging out in the background, the MAPD copays will stand, including the 20% chemo charge that this client is set to start incurring sometime this week.

The whole thing sucked. But, what I learned is yes: a formal investigation is the only way to un-do this, otherwise any medical services rendered during the month of April will be on the MAPD, and the MAPD only. Everything else would have only fixed the problem from May 1st forward. Both of our non-client clients need to make sure that the current supp stays in force and doesn't lapse.

It is such bullsh*t that these telemarketers are able to skirt the system and use call centers in the Philippines to cold call these people. They are preying on a group of people who don't understand the system and a lot of the time are in various stages of cognitive decline. It is so messed up, and it pisses me off.

 

[DonP]

I just dealt with a situation like this.
This client was referred to me on March 28th, 2022. He had his Part A, Part B, drug plan, and was SLMB. He had just been diagnosed with cancer. Instead of taking the sale for myself, I sent him to my competition, because there is a regional hospital system in my area that offers their own Medicare Select supplements, and has decided to open their plan G up for the rest of the year - no underwriting. And, it is significantly cheaper than normal supplements. (I wish I could sell this thing, but they only let their own captive agents sell it.) I have sent them a lot of people at this point because there are situations where it is the best thing for the client. So, I sent him there, he met with their agent the next day, March 29th and she was able to get him a 03/30/2022 start date.
BUT, we just found out on Friday ( 04/08/2022) that earlier in the month, client had spoken with a telemarketer about Aetna MAPD. Turns out, the telemarketer had signed the client up for a 4-1-2022 start, without the client realizing it.
This client has a very hard time understanding insurance, but is adamant that he never gave permission to sign up for the Aetna MAPD. He said he was just wanting information on it. I called Aetna multiple times asking for the enrollment to be rescinded. They said no. We called Medicare to see if there was any way to rescind the enrollment and their answer was yes: with a formal complaint against the agent, and an investigation. The client responded that that was what he wanted to do. From that point forward, I stayed out of the way on the phone call because I didn't want to influence the process at all, so I was a fly on the wall listening to the Medicare representative go through the process with the client. According to the rep (who identified as a Tier 2 specialist), the investigation will take about 30 days. If it goes in the client's favor, the MAPD will be removed and his old drug plan put back in it's spot. The Medicare rep also took an enrollment from the client over the phone for his old PDP for a 5/01/2022 start, in case the investigation concludes that there was not a marketing misrepresentation, that way he would at least be back on his old PDP come May 1. (I think she used LIS-Maintaining for that one.)

The problem is the supplement cannot pay after the MAPD, so the only way to get the supplement coverage for the month of April is for Medicare to overturn the MAPD enrollment. Otherwise, even with the supplement hanging out in the background, the MAPD copays will stand, including the 20% chemo charge that this client is set to start incurring sometime this week.

The whole thing sucked. But, what I learned is yes: a formal investigation is the only way to un-do this, otherwise any medical services rendered during the month of April will be on the MAPD, and the MAPD only. Everything else would have only fixed the problem from May 1st forward. Both of our non-client clients need to make sure that the current supp stays in force and doesn't lapse.

It is such bullsh*t that these telemarketers are able to skirt the system and use call centers in the Philippines to cold call these people. They are preying on a group of people who don't understand the system and a lot of the time are in various stages of cognitive decline. It is so messed up, and it pisses me off.

I used to think how you did . That the client was taken advantage of . These reps are on recorded lines which will be pulled on a complaint . I have no doubt your client although he didn’t understand gave his consent . I had a client who was switched to a aetna pdp . She swore to me she didn’t . We called aetna to cancel the app . She admitted she was on pain pills and started cursing about the advantage of her . The Aetna rep actually took the agents side . Anyway she filed a complaint.

 

[somarco]

@Brande thank you very much for this detailed response.

 

[TwoCents]

Not sure why everyone is concerned about trial rights and SEPs, etc, etc. File a complaint with Medicare (I would use their online form) and clearly state that the MAPD enrollment was fraudulent and should be cancelled as if never enrolled and that the PDP should be reinstated effective XX date (without lapse). It's not that hard!