I know that insureds currently enrolled in a MAPD like Coventry's Advantra Freedom PFFS qualify for a Med Supp guaranteed issue period due to the plan being terminated.
But what about this case:
The client has been enrolled in the Humana Gold Choice PFFS H1804-081 for the past three years. This plan will no longer be available for the plan year 2010.
According to Humana, insureds who take no action will automatically be rolled into a new plan, H2944-017, rather than be automatically returned to Original Medicare.
Although this client has been happy with their MAPD coverage, even in the face of a large claim, they didn't like the nightmarish job of cross referencing EOBs with provider bills, endless EOB errors & corrections, and the mountainous piles of paper.
The client has expressed a desire to return to Original Medicare but will not qualify for a fully underwritten Med Supp.
After calling Humana and being shuffled around to seven different MAPD ?professionals?, Humans states that although this person's plan is not being renewed, they are being migrated into a new plan and therefore don't qualify for Med Supp guaranteed issue.
I know that insureds currently enrolled in a MAPD like Coventry's Advantra Freedom PFFS qualify for a Med Supp guaranteed issue period due to the plan being terminated.
But what about this case:
The client has been enrolled in the Humana Gold Choice PFFS H1804-081 for the past three years. This plan will no longer be available for the plan year 2010.
According to Humana, insureds who take no action will automatically be rolled into a new plan, H2944-017, rather than be automatically returned to Original Medicare.
Although this client has been happy with their MAPD coverage, even in the face of a large claim, they didn't like the nightmarish job of cross referencing EOBs with provider bills, endless EOB errors & corrections, and the mountainous piles of paper.
The client has expressed a desire to return to Original Medicare but will not qualify for a fully underwritten Med Supp.
After calling Humana and being shuffled around to seven different MAPD ?professionals?, Humans states that although this person's plan is not being renewed, they are being migrated into a new plan and therefore don't qualify for Med Supp guaranteed issue.
Is this correct?
That person's plan is ending. They are entitled to a GI for a med sup.
Coventry ended several plans last year and, if you did nothing, you moved into another plan. Those folks still had the opportunity to get a med sup on a GI basis. I did several. I had to send in the letter that they got from Coventry with the med sup apps., but, everyone of them was issued.
Humana is just trying to pull another one their shady deals. Why any agent would write for them is just beyond understanding.
That person's plan is ending. They are entitled to a GI for a med sup.
Coventry ended several plans last year and, if you did nothing, you moved into another plan. Those folks still had the opportunity to get a med sup on a GI basis. I did several. I had to send in the letter that they got from Coventry with the med sup apps., but, everyone of them was issued.
Humana is just trying to pull another one their shady deals. Why any agent would write for them is just beyond understanding.
What jdeasy said. He is right on the money.
You will probably have to submit the letter of cancellation with the Med Supp app. To learn exactly what documentation the Med Supp company requires you may want to give the underwriting dept a call and speak to an underwriter.
Humana is BS'ing you. There ought to be a law, that is enforceable.
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I know that insureds currently enrolled in a MAPD like Coventry's Advantra Freedom PFFS qualify for a Med Supp guaranteed issue period due to the plan being terminated.
But what about this case:
The client has been enrolled in the Humana Gold Choice PFFS H1804-081 for the past three years. This plan will no longer be available for the plan year 2010.
According to Humana, insureds who take no action will automatically be rolled into a new plan, H2944-017, rather than be automatically returned to Original Medicare.
Although this client has been happy with their MAPD coverage, even in the face of a large claim, they didn't like the nightmarish job of cross referencing EOBs with provider bills, endless EOB errors & corrections, and the mountainous piles of paper.
The client has expressed a desire to return to Original Medicare but will not qualify for a fully underwritten Med Supp.
After calling Humana and being shuffled around to seven different MAPD ?professionals?, Humans states that although this person's plan is not being renewed, they are being migrated into a new plan and therefore don't qualify for Med Supp guaranteed issue.
Is this correct?
Your client will absolutely qualify. After reading the post on this forum, Humana must be a real winner.
A muckitty muck from a very large Medicare Advantage company told me that they are pushing CMS for "Mapping" of their PFFS plan terminations into either PPO or HMO plans for next year. Don't ya think that they will once again get their way?
Oh, and this would also mean Rick's mapped renewals will be SOL. Seems like these carriers have an out for people like Rick!
You will probably have to submit the letter of cancellation with the Med Supp app. .
Specifically, the ANOC "non renewal" letter that was probably rec'd by your client several weeks ago.
Non renewal of a PFFS would trigger GI back to a Med Supp even if the carrier is mapping/migrating these people to another PFFS.
Specifically, the ANOC "non renewal" letter that was probably rec'd by your client several weeks ago.
Non renewal of a PFFS would trigger GI back to a Med Supp even if the carrier is mapping/migrating these people to another PFFS.
Not just PFFS, any plan that is ending would give the GI.
A muckitty muck from a very large Medicare Advantage company told me that they are pushing CMS for "Mapping" of their PFFS plan terminations into either PPO or HMO plans for next year. Don't ya think that they will once again get their way?
Oh, and this would also mean Rick's mapped renewals will be SOL. Seems like these carriers have an out for people like Rick!
Am I the only one that thinks this is BS. I mean they "cancel" a conract and if the client's notice got lost in the mail they are "automatically" crammed into a PPO or HMO plan without their consent, knowledge, or participation in plan selection.
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Originally Posted by Yoda
That being said for the most part I think Michael Moore is dead on. .
Am I the only one that thinks this is BS. I mean they "cancel" a conract and if the client's notice got lost in the mail they are "automatically" crammed into a PPO or HMO plan without their consent, knowledge, or participation in plan selection.
I think calling it BS is way too kind. How about robbery, unethical, cheating and @#$%$#.
And CMS is worried about agents ripping off seniors. What a joke all their crap is when they allow companies to pull this kind of stuff.
Am I the only one that thinks this is BS. I mean they "cancel" a conract and if the client's notice got lost in the mail they are "automatically" crammed into a PPO or HMO plan without their consent, knowledge, or participation in plan selection.
I felt the same way last year when Coventry was changing the plans. If you did nothing, your plan was changed. To go back to original Medicare, the enrollee had to send a signed form to Coventry.
It should not be that way. If your plan ends, you should be returned to original Medicare unless you take action to enroll in something else.
We don't have that problem this year with Wellcare and Coventry completely ending with nothing to slam people into.
Speaking of Humana being BS....I use to write for Kanawha Insurance Company. They got bought out by Humana, which was paying me renewals each month through August 2009 and then they quit paying me. I phoned Humana last Friday and the lady said they would check into it and email me.
That person's plan is ending. They are entitled to a GI for a med sup.
Coventry ended several plans last year and, if you did nothing, you moved into another plan. Those folks still had the opportunity to get a med sup on a GI basis. I did several. I had to send in the letter that they got from Coventry with the med sup apps., but, everyone of them was issued.
Humana is just trying to pull another one their shady deals. Why any agent would write for them is just beyond understanding.
100% correct.
It's not up to Humana whether or not they are GI. You will get nothing but idiots up there so don't bother calling them. I had the same thing happen with Coventry when they ended Freedom 1 and autoenrolled folks into Freedom 1B (which was crap). They were GI and I wrote them Med Supps.
Coventry and Humana are both garbage. I literally walked out of a certification class in Nashville last year because I realized how sh!tty their 09 plans were, and the instructors were idiots. Guess it runs in the whole organization.
How can Humana get away with this? Two PFFS plans were available state wide in 2009:
Humana Gold Choice PFFS H1804-081, and Humana Gold Choice PFFS H1804-210
Only one plan being offered for 2010:
Humana Gold Choice PFFS H2944-017
Members of both 2009 plans are automatically being migrated into the 2010 plan.
I told this client that they should be eligible for a med supp guaranteed issue should they choose to return to Original Medicare.
Now I have seen the ANOC letter Humana sent to this client. It states, "We want to let you know that we have changed our plan name from Humana Gold Choice PFFS H1804-081 to Humana Gold Choice H2944-017 (PFFS) for the upcoming year. If you do not choose another plan, or choose to return to Original Medicare, you will be enrolled in the Humana Gold Choice H2944-017 (PFFS) next year."
19 Counties will have no plan available and are being terminated. They are in a guaranteed issue period.
In 1 County, one 2010 plan is available called Humana Gold Choice H2944-072 (PFFS). Humana is not calling this plan change merely a "name change" as in the other counties. These members are being terminated and also have a guaranteed issue.
While I still believe this client should be eligible for a guaranteed issue, Humana will not provide a non-renewal ANOC letter need to satisfy the requirement of the med supp carrier.
Since CMS has so many intricate rules and regulations in place, supposedly to protect medicare beneficiaries, why do they allow this sleight of hand by Humana?
Oh no no no no no, we're not changing the plan, we're just changing the name of the plan.
How can you go from two plans to one plan and tell members of both plans it's just a name change! This is making me very angry!
Med Supp Guaranteed Issue from MAPD
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