SEP Permanent Move MAPD

[kstein]

Anyone come across this? Client is on MAPD PPO with $6000 max. He's been on it for about 3 years and moves 7/1 to a different county (but still in the service area of the original MAPD).

Is this GI into a sup? I remember seeing something that would allow a person to change plans even if they move across the street but I'm not 100% sure.

 

[DS4]

Anyone come across this? Client is on MAPD PPO with $6000 max. He's been on it for about 3 years and moves 7/1 to a different county (but still in the service area of the original MAPD).

Is this GI into a sup? I remember seeing something that would allow a person to change plans even if they move across the street but I'm not 100% sure.

No SEP.
How can it be a SEP if he is still resides in the same MA's service area?

 

[Hopes]

Anyone come across this? Client is on MAPD PPO with $6000 max. He's been on it for about 3 years and moves 7/1 to a different county (but still in the service area of the original MAPD).

Is this GI into a sup? I remember seeing something that would allow a person to change plans even if they move across the street but I'm not 100% sure.

Since he is moving to a different county, he will have a SEP if there are different plans available.
https://www.gohealthvmo.com/wp-cont...-Medicare-Plan-Enrollment-Options-AP-164a.pdf

 

[Chazm]

There's no such thing as a SEP for a med supp. If it were to another service area you could switch mapd plans but there's no gi to med supp.

 

[Hopes]

There's no such thing as a SEP for a med supp. If it were to another service area you could switch mapd plans but there's no gi to med supp.

I didn't catch the med supp part in the op before. For my own education, if a client moves out of the MAPD service area, he would then qualify for guaranteed issue, right?

 

[Chazm]

I didn't catch the med supp part in the op before. For my own education, if a client moves out of the MAPD service area, he would then qualify for guaranteed issue, right?

Yes .

 

[sman]

No .

You might want to go back and read that.

if a client moves out of the MAPD service area, he would then qualify for guaranteed issue, right?

This would qualify for a GI into a Med Supp.

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Since he is moving to a different county, he will have a SEP if there are different plans available.
https://www.gohealthvmo.com/wp-cont...-Medicare-Plan-Enrollment-Options-AP-164a.pdf

You have misinterpreted this. Moving to a different county, but still within the service area of the current MAPD would not qualify as an SEP.

 

[Chazm]

You might want to go back and read that.

if a client moves out of the MAPD service area, he would then qualify for guaranteed issue, right?

This would qualify for a GI into a Med Supp.

I must be having a huge brain fart because I have never heard of that. I do see it on Medicare.gov

 

[traceyemoon]

It only qualifies to enroll in MA/MAPD/PDP:

"service area
2) Individuals who were not eligible for a MA or PDP because they had been out of the U.S. and have now moved back or those were incarcerated and now have released
3) Plan learns that individual has been out of the service area more than 6 months and member has been disenrolled
4) Member notifies plan that they moved or have been out of the service area for 6 months or more and have yet to be disenrolled
1) SEP available for permanent change of residence. Can complete application the month prior to the permanent move and up to 2 months after the move. The applicant may choose an effective date of up to 3 months after the month in which the enrollment form is received but the effective date may NOT be earlier than the date of permanent move. May enroll in any plan for which the beneficiary is eligible in the new service area, regardless of coverage in former service area. Individuals who move and have new Medicare health or Part D plans available to them as a result of the move, but continue to reside in the current plan service area, may use this SEP to enroll in a different plan. Zip code or county must change.
NOTE: If member notifies the plan of a specific future move date (for the following or subsequent future month), the SEP begins the month of the move date."

UNDER THE ELECTION TYPE CODE & NOTES:

"1) SEP - MOV
For enrollment into MA, MAPD or PDP"

 

[TwoCents]

It only qualifies to enroll in MA/MAPD/PDP:

"service area
2) Individuals who were not eligible for a MA or PDP because they had been out of the U.S. and have now moved back or those were incarcerated and now have released
3) Plan learns that individual has been out of the service area more than 6 months and member has been disenrolled
4) Member notifies plan that they moved or have been out of the service area for 6 months or more and have yet to be disenrolled
1) SEP available for permanent change of residence. Can complete application the month prior to the permanent move and up to 2 months after the move. The applicant may choose an effective date of up to 3 months after the month in which the enrollment form is received but the effective date may NOT be earlier than the date of permanent move. May enroll in any plan for which the beneficiary is eligible in the new service area, regardless of coverage in former service area. Individuals who move and have new Medicare health or Part D plans available to them as a result of the move, but continue to reside in the current plan service area, may use this SEP to enroll in a different plan. Zip code or county must change.
NOTE: If member notifies the plan of a specific future move date (for the following or subsequent future month), the SEP begins the month of the move date."

UNDER THE ELECTION TYPE CODE & NOTES:

"1) SEP - MOV
For enrollment into MA, MAPD or PDP"

Two different things are being discussed and you have to be able to connect the dots even if the terminology isn't used absolutely correctly.

Moving outside your MA's service area would put the client in a GI situation.
https://www.medicare.gov/supplement...eed-issue-rights-scenarios.html#collapse-4690