Move back to 'regular' Medicare now (after 1-1-08)Go to Top
Met a woman in line at grocery store's pharmacy today.
We got to talking. (She is interested in LTC.) She has a MA plan with a built-in part D plan and does not like it (I didn't ask why.) She wants to go back to 'regular' Medicare and a stand-alone part-D (like she used to have) and asked if she could do it now (in this OE period.)
I told her I was not sure and that I'd get back to her. What do I tell her? I know you can go from "like" to "like" before March... but can you revert back to Medicare and a new Part-D only... or did that end the other day? If she CAN do it, how is it done? Writing CMS? Contacting her MA carrier?
I don't think a lot of seniors understand the deadlines. I don't do much beyond sups with seniors so I don't know the arcane MA rules.
Re: Move back to 'regular' Medicare now (after 1-1-08)Go to Top
Switching from a MAPD (Medicare Advantage with Prescription Drugs) back to Original Medicare with a Stand Alone Part D plan (PDP) is considered "like for like" and can be done during the Open Enrollment Period (OEP) from January 1st to March 31st.
She gets one change during OEP, so she'll be "locked in" to original Medicare until 1/1/09.
She just needs to enroll in a PDP plan. If you are the agent, just indicate that this is an OEP period enrollment. Or, she can call 800-MEDICARE and they'll do it for her.
Part D plan will be effective 2/1/08, assuming she does it this month.
Also, if she had a Medigap policy and dropped it to join the MAPD plan, she would be eligible for Guarantee Issue (if this was her first time in a MA plan). Or you could underwrite her into a new plan, if she passed underwriting.
Re: Move back to 'regular' Medicare now (after 1-1-08)Go to Top
Originally Posted by craig_ritter
Switching from a MAPD (Medicare Advantage with Prescription Drugs) back to Original Medicare with a Stand Alone Part D plan (PDP) is considered "like for like" and can be done during the Open Enrollment Period (OEP) from January 1st to March 31st.
She just needs to enroll in a PDP plan. If you are the agent, just indicate that this is an OEP period enrollment. Or, she can call 800-MEDICARE and they'll do it for her.
Part D plan will be effective 2/1/08, assuming she does it this month.
Craig
Thanks Craig. One question. How does she stop her MAPD so that it reverts back to Medicare? Does she contact the carrier (she does not remember who her agent is.) Or does just enrolling into a new Part D going to automatically have CMS drop her MA plan and put her back on Medicare?
Re: Move back to 'regular' Medicare now (after 1-1-08)Go to Top
Originally Posted by al3
Thanks Craig. One question. How does she stop her MAPD so that it reverts back to Medicare? Does she contact the carrier (she does not remember who her agent is.) Or does just enrolling into a new Part D going to automatically have CMS drop her MA plan and put her back on Medicare?
Al
No problem.
Technically, she doesn't need to contact her current carrier. When she enrolls in the Stand Alone Part D plan, it will automatically disenroll her from the MA-PD as far as CMS is concerned.
Assuming she's paying a premium for the MA-PD, it still might not be a bad idea to give them a call, especially if she's on bank draft with the MA-PD company to pay the premium, so she can cancel the bank draft.
If Social Security is deducting the premium, it might take a little while to make the change, but eventually, she'll get the money back. Social Security has historically been pretty slow to make changes. I'd advise her to call Social Security as well if this is the case to have them stop deducting the premium from her Soc. Security check (can't hurt).
Assuming she's financially and health qualified for LTCI, she'd probably be suitable for Medigap as well. I have a web-enabled Medigap quote calculator, but it only works in 10 states. PM me her zip, age, etc. and I'll e-mail a quote, if I have it available in your state.
Re: Move back to 'regular' Medicare now (after 1-1-08)Go to Top
Thanks again. I emailed her with the news. She has a zero-prem MA-PD. She is on a whole bunch of drugs so I'll help her find a part-D plan that will work for her. I'm familiar with those as my wife is on the Blue Cross plan.
As for LTC, I'm pretty familiar with that market and those products and I would doubt that she would get past UW, but I'll look into it.
Maybe I should "hang-out" at the pharmacy counter of my grocery store more often! I'll tell my doctor to limit my script to a weekly supply so I have to keep going back! Earlier this year I met a client on the same line... wrote a Blue Shield plan for her self-employed commercial artist daughter. Now that I think of it, I've written a fair number of plans for people I just casually met on a line waiting for service at the pharmacy, at the coffee shop, and at the vet (woman wanted to know about pet insurance... I wrote her an HSA for herself.)
John P. is right. People are happy to talk (gripe) about health insurance. If there is a sale to be made there it is not hard to make it. However they run like hell if you mention life insurance!
Re: Move back to 'regular' Medicare now (after 1-1-08)Go to Top
Originally Posted by al3
Thanks again. I emailed her with the news. She has a zero-prem MA-PD. She is on a whole bunch of drugs so I'll help her find a part-D plan that will work for her. I'm familiar with those as my wife is on the Blue Cross plan.
As for LTC, I'm pretty familiar with that market and those products and I would doubt that she would get past UW, but I'll look into it.
Maybe I should "hang-out" at the pharmacy counter of my grocery store more often! I'll tell my doctor to limit my script to a weekly supply so I have to keep going back! Earlier this year I met a client on the same line... wrote a Blue Shield plan for her self-employed commercial artist daughter. Now that I think of it, I've written a fair number of plans for people I just casually met on a line waiting for service at the pharmacy, at the coffee shop, and at the vet (woman wanted to know about pet insurance... I wrote her an HSA for herself.)
John P. is right. People are happy to talk (gripe) about health insurance. If there is a sale to be made there it is not hard to make it. However they run like hell if you mention life insurance!
Thanks again, Craig.
Al
Just as a side comment, you mentioned that she wants switch back that she did not say why. Be sure to take the two minutes to ask her why because it is still a transaction where you have to determine suitability before moving the client. She will end out with some exposure if she just lands back in original medicare with no med supp and she will be as happy to bitch about that to someone when the surprises come up as she was to bitch to you about the med advantage plan. She may be unhappy with the MA because she does not know what it does and how it works and what value she is getting and with the proper understanding maybe she would still want it. Maybe not. Take the two mintues.
Re: Move back to 'regular' Medicare now (after 1-1-08)Go to Top
Have her apply for the supplement prior to canceling her MAPD. If there is a situation where she cannot qualify, then she is not subject to a lapse in coverage. Once she is approved, then she can drop her MAPD in full confidence.
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"Government's view of the economy could be summed up in a few short phrases: If it moves, tax it. If it keeps moving, regulate it. And if it stops moving, subsidize it." Ronald Reagan
Re: Move back to 'regular' Medicare now (after 1-1-08)Go to Top
Originally Posted by midwestbroker
Have her apply for the supplement prior to canceling her MAPD. If there is a situation where she cannot qualify, then she is not subject to a lapse in coverage. Once she is approved, then she can drop her MAPD in full confidence.
During this OEP why would there be ANY lapse in coverage?
As for a med sup, I doubt she can get through UW... and I'm not even sure she can afford the premium. I still have a lot of fact-finding to do, but since she has until March 31, I've got some time. I think she is under-age and on disability... I need to find out a lot more obviously. At this point she is just a prospect I met in the pharmacy line.... not a client!
All I know is that she does not see the 'advantage' in MA. She is on the Blue Cross Freedom no premium plan, but has a $1200 deduct (if I remember correctly) and a $3K annual max. I think THAT is what spooks her... plus she has seen all the anti-MA stuff in the press lately.
My wife is on same plan (via disability) the past year... which she likes and has had no problems with. I don't think it is as good as the SCAN plan in the Los Angeles area (not up here), but Blue Cross has a huge network and wife had no issues getting her meds (lots of them!) claims paid, etc. (which is how it should be. I'd rather Jane get a sup but she is underage and has to go through UA... and no way Jose will she pass!)
Note: good site that explains the enrollment periods and what is allowed.
Re: Move back to 'regular' Medicare now (after 1-1-08)Go to Top
Al: Just a friendly warning... if you discuss MAs or PDPs in line at a pharmacy counter you will be considered in violation of CMS marketing guidelines. You are not supposed to be near the point where prospects are receiving medical service or pharmacy benefits. You are supposed to be in a "common" area, i.e. somewhere else in the Pharmacy, not close to the Pharmacist's counter. Same as with doctor's office or hospital, you must be in the lobby, cafeteria, etc. but not in the waiting rooms.
Also, we are using the term "Original Medicare" to describe plan H0000-001 which is the government fee-for-service plan. I know customers do not understand all the terms, but as an agent I try to use the proper terminology in my conversation, so that eventually they get the message. We especially need to use the proper terminology when talking to one another in order to keep our professionalism at a high standard and in this way we help one another.
Re: Move back to 'regular' Medicare now (after 1-1-08)Go to Top
Originally Posted by retread
Al: Just a friendly warning... if you discuss MAs or PDPs in line at a pharmacy counter you will be considered in violation of CMS marketing guidelines. You are not supposed to be near the point where prospects are receiving medical service or pharmacy benefits. You are supposed to be in a "common" area, i.e. somewhere else in the Pharmacy, not close to the Pharmacist's counter. Same as with doctor's office or hospital, you must be in the lobby, cafeteria, etc. but not in the waiting rooms.
Also, we are using the term "Original Medicare" to describe plan H0000-001 which is the government fee-for-service plan. I know customers do not understand all the terms, but as an agent I try to use the proper terminology in my conversation, so that eventually they get the message. We especially need to use the proper terminology when talking to one another in order to keep our professionalism at a high standard and in this way we help one another.
Happy New Year!
Are the fees standardized or a percentage of your sales?
Re: Move back to 'regular' Medicare now (after 1-1-08)Go to Top
I just finished a national Blue Cross-Anthem phone/web seminar designed to tell agents what is and is not allowed during OEP and I asked the question about reverting back to traditional medicare and they emphatically said NO, it can't be done during this period unless there is an event to trigger a SEP.
Several people questioned the response but the gal on the panel who is a compliance drone said no, can't be done because of part-D rules.
I asked if a person who had a MA-PD simply wanted to revert back to traditional medicare AND would keep or buy the current part-D... and she said CMS does not allow it. In fact she said there is no way to revert back to traditional medicare until next Nov. 15.
I don't know what is what anymore. No wonder people are confused as hell.
Re: Move back to 'regular' Medicare now (after 1-1-08)Go to Top
Originally Posted by al3
I just finished a national Blue Cross-Anthem phone/web seminar designed to tell agents what is and is not allowed during OEP and I asked the question about reverting back to traditional medicare and they emphatically said NO, it can't be done during this period unless there is an event to trigger a SEP.
Several people questioned the response but the gal on the panel who is a compliance drone said no, can't be done because of part-D rules.
I asked if a person who had a MA-PD simply wanted to revert back to traditional medicare AND would keep or buy the current part-D... and she said CMS does not allow it. In fact she said there is no way to revert back to traditional medicare until next Nov. 15.
I don't know what is what anymore. No wonder people are confused as hell.
Al
This is not the first time I have run across so-called "experts" that make errant statements. This person is wrong, wrong, wrong. Anyone with a MAPD that wants to enroll in Original Medicare(OM) w/PDP during the OEP is allowed. The link to the Coventry chart posted above also agrees with my statement. No requirement for SEP under this situation. What you CANNOT do is go from OM w/PDP to OM w/another PDP. This would require them to drop one PDP and enroll in another, which is forbidden. I use the simple phrase "You cannot pick up or drop a PDP during the OEP" to summarize the rules. (This is a little over-simplified, but works in most cases).
Speaking of errancy, even the Coventry chart needs a little brush work.... the first box should read N/A. No one goes from OM to OM.
Re: Move back to 'regular' Medicare now (after 1-1-08)Go to Top
Originally Posted by retread
What you CANNOT do is go from OM w/PDP to OM w/another PDP. This would require them to drop one PDP and enroll in another, which is forbidden. I use the simple phrase "You cannot pick up or drop a PDP during the OEP" to summarize the rules. (This is a little over-simplified, but works in most cases).
Well wait a second. If person has an MAPD (embedded) can he move to TM and buy a stand alone PDP? Your statement above does not take into account those MA plans that have PD included.
(Not arguing... just trying to figure this mess out!)
Re: Move back to 'regular' Medicare now (after 1-1-08)Go to Top
Originally Posted by al3
Well wait a second. If person has an MAPD (embedded) can he move to TM and buy a stand alone PDP? Your statement above does not take into account those MA plans that have PD included.
(Not arguing... just trying to figure this mess out!)
Al
That's what I just stated. You can go from MAPD (MA plan w/PDP) to OM (Original Medicare, as it is termed by CMS) and a PDP. This is one of the cases where my little ditty needs some brushwork. In this case, the MAPD usually can't be disassociated, so you have to enroll in a different PDP. This is about the only time "picking up" a PDP is allowed. (You are not really "picking up" a PDP, but continuing drug coverage due to the bundling of the MA plan.) You CANNOT drop one stand-alone PDP to enroll in another stand-alone PDP, but you CAN change plans that involve bundled PDPs. CMS just wants to eliminate starting or stopping drug coverage during this time. The emphasis is on CONTINUING the drug coverage the beneficiary had on 12/31, whether NONE or whatever.
Re: Move back to 'regular' Medicare now (after 1-1-08)Go to Top
OK. Thanks. So it is established that a person with... say non-prem Pyramid (embedded) MAPD.... can drop it BY BUYING a Humana PDP ... which will automatically revert them back to OM in CMS's computer system.
Does CMS send the person a confirmation letter... telling the to start using their red/white Medicare card again?
Re: Move back to 'regular' Medicare now (after 1-1-08)Go to Top
Originally Posted by al3
OK. Thanks. So it is established that a person with... say non-prem Pyramid (embedded) MAPD.... can drop it BY BUYING a Humana PDP ... which will automatically revert them back to OM in CMS's computer system.
Does CMS send the person a confirmation letter... telling the to start using their red/white Medicare card again?
Al
I really don't know, but I am guessing that they will send a "Welcome to Medicare" brochure and letter, just as if they were new to medicare. I never got feedback from my former clients when I did this, because they were no longer my clients.
Move back to 'regular' Medicare now (after 1-1-08)
if you discuss MAs or PDPs in line at a pharmacy counter you will be considered in violation of CMS marketing guidelines. You are not supposed to be near the point where prospects are receiving medical service or pharmacy benefits. You are supposed to be in a "common" area, i.e. somewhere else in the Pharmacy, not close to the Pharmacist's counter. Same as with doctor's office or hospital, you must be in the lobby, cafeteria, etc. but not in the waiting rooms.
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