Insurance Agent Forum

[insurance0707]

I started getting phone calls from my clients this last Sunday. I got 10 more calls on Monday. The insurance carriers are sending out letters, not to everyone but to those they can't verify for sure that they had credible coverage on their MAPD or PDP plans for 2006 and 2007.

[COLOR=black]What is happening is that CMS is beginning to review when a member was eligible for their PDP or MAPD to determine if the Late Enrollment Penalty (LEP) should apply. While CMS talked about applying it they never actually did. Now they are beginning to look at people and asking for creditable coverage if necessary. CMS has asked all carries to begin a audit period and forward the information to CMS so they can determine if an LEP will be applied to the member or not.[/COLOR]

[Cenla Agent]

Originally Posted by insurance0707

I started getting phone calls from my clients this last Sunday. I got 10 more calls on Monday. The insurance carriers are sending out letters, not to everyone but to those they can't verify for sure that they had credible coverage on their MAPD or PDP plans for 2006 and 2007.

[COLOR=black]What is happening is that CMS is beginning to review when a member was eligible for their PDP or MAPD to determine if the Late Enrollment Penalty (LEP) should apply. While CMS talked about applying it they never actually did. Now they are beginning to look at people and asking for creditable coverage if necessary. CMS has asked all carries to begin a audit period and forward the information to CMS so they can determine if an LEP will be applied to the member or not.[/COLOR]

I started getting calls back in August from Humana PDP enrollees who were getting the letter. Most clients mistakenly assume that the ins. co. is penalizing them whereas of course it is CMS.

[scottfree]

Originally Posted by Cenla Agent

I started getting calls back in August from Humana PDP enrollees who were getting the letter. Most clients mistakenly assume that the ins. co. is penalizing them whereas of course it is CMS.

I also started getting these calls from my Humana Clients in August. Several of these had VA coverage and most of the others had group coverage prior to getting a PDP. Out of the 20+ calls I received, only one I believe will get a penalty and that was someone that believed they were having premium taken out of SS and was cancelled by Humana. It was there fault because they had sent letters to inform them of this problem but they got so much junk mail from Humana that they threw it out.

What did the penalty turn out to be? Anyone know? I think it is around .28 cents a month.

Scott

[retread]

For further emphasis, my retiree insurance company sent me a letter of credible coverage in August. I agree with the analysis aforementioned. Apparently CMS is getting all their ducks in a row to begin enforcement.

[midwestbroker]

Medicare is playing catch up with all the enrollees.

I have had numerous calls about it. It only took them 2 years to send out the letters.

I wonder how they are going to retro back the prior penalties that they have not been collecting.

[Cenla Agent]

Originally Posted by scottfree

I also started getting these calls from my Humana Clients in August. Several of these had VA coverage and most of the others had group coverage prior to getting a PDP. Out of the 20+ calls I received, only one I believe will get a penalty and that was someone that believed they were having premium taken out of SS and was cancelled by Humana. It was there fault because they had sent letters to inform them of this problem but they got so much junk mail from Humana that they threw it out.

What did the penalty turn out to be? Anyone know? I think it is around .28 cents a month.

Scott

They were cancelled b/c they never sent in any $$ and didn't confirm it was actually coming out of their check.

I can understand throwing away everything b/c of junk, but I've advised all of my clients to open everything first to make sure it isn't junk. I've seen thrown away id cards, etc b/c they thought it was junk and have seen welcome kits for MA plans they didn't even know they had enrolled in.