Insurance Agent Forum

[TRK3031962]

I just went to switch a client from an MA plan back to a med supp per her request. I found out that she has cataract surgery scheduled in January. Once she has the surgery, can I switch her from the MA to a med supp at that point or is she stuck for another year with the MA (PFFS)?

[jdeasy]

Originally Posted by TRK3031962

I just went to switch a client from an MA plan back to a med supp per her request. I found out that she has cataract surgery scheduled in January. Once she has the surgery, can I switch her from the MA to a med supp at that point or is she stuck for another year with the MA (PFFS)?

Anytime during OEP, she can return to original medicare. She could then buy a med sup.

[insurance0707]

She can also enroll in a PDP along with the Med supp if the plan she has is an MAPD plan

[retread]

Originally Posted by insurance0707

she can also enroll in a PDP along with the Med supp if the plan she has is an MAPD plan

Not just "can", but "must"! For a bene with a MAPD leaving the AEP and going into the OEP, once in the OEP, the bene cannot drop a PDP, so if they decide to go with Original Medicare (OM), they MUST enroll in a stand-alone PDP. This simply continues the Part D benefits.... the point is: Outside the AEP one cannot pick up or drop prescription drug coverage. So if he/she had Part D benefits coming into the OEP, he/she must exit the OEP with Part D benefits.
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Originally Posted by TRK3031962

I just went to switch a client from an MA plan back to a med supp per her request. I found out that she has cataract surgery scheduled in January. Once she has the surgery, can I switch her from the MA to a med supp at that point or is she stuck for another year with the MA (PFFS)?

What is she trying to do? get around paying the PFFS outpatient copay? All MA plans must cover cataract surgery available under OM. If the PFFS plan has onerous outpatient co-pays, she may be better off staying with OM once the switch is made. If someone has cataract surgery in one eye, they more than likely will need it in the other. If both eyes can be done in the same month, so much the better, but if it were me, I would wait at least a month or two post surgery until switching back to the PFFS so she won't be hit with another outpatient procedure if she incurs one due to complications. What you should do is calculate the cost of the Med Sup for those few months against the outpatient co-pay. She may find it will cost less to remain with the PFFS. Take the time to do the math.

The only other issue I can think of is the choice of doctor... if the doctor she wants to use doesn't accept the PFFS plan then in my opinion she would be better off staying with OM, since she needs to have him available for post-surgery followup.

[honestagent]

I am confused; what exactly are you asking? Did you physically change her plan?

If so, has she been approved yet?

If you did, did she/you elect a pdp?

Originally Posted by TRK3031962

I just went to switch a client from an MA plan back to a med supp per her request. I found out that she has cataract surgery scheduled in January. Once she has the surgery, can I switch her from the MA to a med supp at that point or is she stuck for another year with the MA (PFFS)?

[TRK3031962]

Ok, guys....thanks for all the answers. I tried to keep this simple. She just wants back on a med supp where she feels more comfortable with NO copays.
She has already had on cateract removed and was scheduled for the other in Oct. However, her husband passed away and she had to reschedule it. I couldn't switch her from the PFFS to a Med Supp because of the scheduled surgery. She would like for me to move her to the Med Supp after the surgery if it is possible. I thought it was possible to do this, but just wanted to make sure.
No, she is NOT on an MAPD.

[retread]

Originally Posted by TRK3031962

ok, guys....thanks for all the answers. I tried to keep this simple. She just wants back on a med supp where she feels more comfortable with NO copays.
She has already had on cateract removed and was scheduled for the other in Oct. However, her husband passed away and she had to reschedule it. I couldn't switch her from the PFFS to a Med Supp because of the scheduled surgery. She would like for me to move her to the Med Supp after the surgery if it is possible. I thought it was possible to do this, but just wanted to make sure.
No, she is NOT on an MAPD.

If she does not have a Prescription drug plan at this time, you know, of course, that she will not be able to get one after 12/31 until next year.... time is running short. I have a concern for why she apparently has an MA only plan.... If she doesn't sign up for a PDP, she will face a penalty of $3.60 per year on top of what she may already have accrued to date.... for the rest of her life! The sooner she bites the bullet and enrolls in a PDP, the better for her. The older she gets, the more susceptible she will be for prescription needs and the higher the penalty that will be added on top of her PDP premium.

[TRK3031962]

Guys, please stop assuming things. I did say PFFS in my original post. I didn't mention anything about a drug plan because i've had her on a Coventry PDP for a few years now. She's set with that. This situation is the very reason why I NEVER couple an MA and PDP together into one plan. One of the plans may still fit the client needs while the other does not. Nope, have never sold an MAPD and never will. I have plenty of MA plans and plenty of PDP plans, but never and MAPD.

[retread]

Originally Posted by TRK3031962

guys, please stop assuming things. I did say PFFS in my original post. I didn't mention anything about a drug plan because i've had her on a Coventry PDP for a few years now. She's set with that. This situation is the very reason why I NEVER couple an MA and PDP together into one plan. One of the plans may still fit the client needs while the other does not. Nope, have never sold an MAPD and never will. I have plenty of MA plans and plenty of PDP plans, but never and MAPD.

NEVER a MAPD? I don't see how you can paint with such a broad brush. I can see selling an MA with a stand-alone PDP in some special situations, but usually it is less costly for the client to take the MAPD plan, especially with Coventry products. Coventry's AdvantraRx Formulary is hard to beat.

I don't know what PFFS product you are pairing with AdvantraRx, but of all the PFFS products I carry, Coventry's ranks among the top in most counties in my area, along with Secure Horizons... although they (SH) are losing their grip because UHC is dropping some favored hospitals. Once Today's Options drops about 50 options to where they are not so overwhelming, they may gain some ground. Only a few of their products are worthwhile anyway.

You do your thing, though... It's your business. However I would caution others who may view this thread not to follow suit with the sales strategy you advocate. "Never say Never" LOL!

[Winter]

Originally Posted by jdeasy

Anytime during OEP, she can return to original medicare. She could then buy a med sup.

She could even go back after OEP if this is her first time in an MA, couln't she?

Winter

[jdeasy]

Originally Posted by Winter

She could even go back after OEP if this is her first time in an MA, couln't she?

Winter

Yes, providing she was in the 12 month window.

[Frank Stastny]

Originally Posted by TRK3031962

guys, please stop assuming things. I did say PFFS in my original post. I didn't mention anything about a drug plan because i've had her on a Coventry PDP for a few years now. She's set with that. This situation is the very reason why I NEVER couple an MA and PDP together into one plan. One of the plans may still fit the client needs while the other does not. Nope, have never sold an MAPD and never will. I have plenty of MA plans and plenty of PDP plans, but never and MAPD.

I guess I'm missing something.

She has a PFFS plan now, you said she wants to "go back to a Med Supp". She is within the twelve month period where she can go back to her Med Supp and have it be guaranteed issue, isn't that correct? By what you said, I am assuming that she formerly had a Med Supp right?

If that is the case you can put her back with the same company and plan as of Jan 1 regardless of the surgery. If you want to place her with a different company then she will probably have to answer the health questions and you should wait until after the surgery to write the app with an effective date a couple of weeks after the surgery.

This may mean that she has to "go bare" for a couple of weeks with only Medicare as her coverage. To me, that isn't a whole lot different than having a PFFS plan.

I don't sell MA/PFFS plans so I have never encountered that situation but it seems pretty cut and dry to me. Then again I may not know what in the hell I'm talking about.

[jdeasy]

Originally Posted by Frank Stastny

I guess I'm missing something.

She has a PFFS plan now, you said she wants to "go back to a Med Supp". She is within the twelve month period where she can go back to her Med Supp and have it be guaranteed issue, isn't that correct? By what you said, I am assuming that she formerly had a Med Supp right?

If that is the case you can put her back with the same company and plan as of Jan 1 regardless of the surgery. If you want to place her with a different company then she will probably have to answer the health questions and you should wait until after the surgery to write the app with an effective date a couple of weeks after the surgery.

This may mean that she has to "go bare" for a couple of weeks with only Medicare as her coverage. To me, that isn't a whole lot different than having a PFFS plan.

I don't sell MA/PFFS plans so I have never encountered that situation but it seems pretty cut and dry to me. Then again I may not know what in the hell I'm talking about.

The original poster has never said that she is still in the 12 month wondow. He did say that she was formerly on a med sup.

Just reading between the lines, I'm thinking she is not still in the 12 month trial period and that's what raises the concern about the pre X.

If she is outside the 12 month trial, she can only drop her PFFS during AEP or OEP unless she qualifies for some SEP. That was his original question.

[Frank Stastny]

Originally Posted by jdeasy

The original poster has never said that she is still in the 12 month wondow. He did say that she was formerly on a med sup.

Just reading between the lines, I'm thinking she is not still in the 12 month trial period and that's what raises the concern about the pre X.

If she is outside the 12 month trial, she can only drop her PFFS during AEP or OEP unless she qualifies for some SEP. That was his original question.

Thanks, I guess I assumed too much. It is so much easier to answer a post when all the information is clearly stated and one doesn't have to guess to try to fill in the blanks.

For my information, can she have the surgery under her PFFS plan in January then drop it effective the end of January? Wouldn't that still be under either the AEP or OEP when she can drop her policy?

If so then can't she apply for the Med Supp literally the day after the surgery and have it go into effect on Feb 1?

This is only one of the many reasons I don't sell PFFS plans.

Thanks JD.

[Winter]

Originally Posted by Frank Stastny

Thanks, I guess I assumed too much. It is so much easier to answer a post when all the information is clearly stated and one doesn't have to guess to try to fill in the blanks.

For my information, can she have the surgery under her PFFS plan in January then drop it effective the end of January? Wouldn't that still be under either the AEP or OEP when she can drop her policy?

If so then can't she apply for the Med Supp literally the day after the surgery and have it go into effect on Feb 1?

This is only one of the many reasons I don't sell PFFS plans.

Thanks JD.

Could probably even apply before the surgery and have it go into effect the first of Feb 1. The question at hand though is: Does "go into effect" include pre-exist or not. Arguably not, unless she is still within her first original year in an MA. Perhaps, the original poster could clarify that rather than have everyone continue to read tea leaves while trying to help.

[jdeasy]

Originally Posted by Frank Stastny

Thanks, I guess I assumed too much. It is so much easier to answer a post when all the information is clearly stated and one doesn't have to guess to try to fill in the blanks.

For my information, can she have the surgery under her PFFS plan in January then drop it effective the end of January? Wouldn't that still be under either the AEP or OEP when she can drop her policy?

If so then can't she apply for the Med Supp literally the day after the surgery and have it go into effect on Feb 1?

This is only one of the many reasons I don't sell PFFS plans.

Thanks JD.

The OEP is from Jan. 1 thru March 31. She can return to original Medicare during this time. She can change to another MA plan during this time. Since she has a PDP, she could even go to an MAPD during that time. None of those seem to be options she is considering, but, she could. The one thing she cannot do is drop her PDP plan or go to another stand alone PDP. Again, that doesn't appear to be a concern anyway.


Yes, anytime in Jan. she can drop the PFFS by going back to original Medicare. Her coverage under the PFFS wouldn't end until Jan. 31. She could go ahead and purchase a med sup to be effective on Feb. 1 and not lose a day of coverage.

[Frank Stastny]

Originally Posted by jdeasy

The OEP is from Jan. 1 thru March 31. She can return to original Medicare during this time. She can change to another MA plan during this time. Since she has a PDP, she could even go to an MAPD during that time. None of those seem to be options she is considering, but, she could. The one thing she cannot do is drop her PDP plan or go to another stand alone PDP. Again, that doesn't appear to be a concern anyway.


Yes, anytime in Jan. she can drop the PFFS by going back to original Medicare. Her coverage under the PFFS wouldn't end until Jan. 31. She could go ahead and purchase a med sup to be effective on Feb. 1 and not lose a day of coverage.

Damn you are good!

Sounds like you are the only one who really answered his original question.

Just like "shake an bake" I helped a little didn't I?

[TRK3031962]

Originally Posted by jdeasy

The OEP is from Jan. 1 thru March 31. She can return to original Medicare during this time. She can change to another MA plan during this time. Since she has a PDP, she could even go to an MAPD during that time. None of those seem to be options she is considering, but, she could. The one thing she cannot do is drop her PDP plan or go to another stand alone PDP. Again, that doesn't appear to be a concern anyway.


Yes, anytime in Jan. she can drop the PFFS by going back to original Medicare. Her coverage under the PFFS wouldn't end until Jan. 31. She could go ahead and purchase a med sup to be effective on Feb. 1 and not lose a day of coverage.

Yes, this is the answer. I'm sorry if I didn't give enough info to begin with. I was really trying to keep it simple. I know all of the other stuff that was posted here about the PDP and the 12 month guarantee and all. I was only concerned whether or not I could change her after the AEP and during the OEP. I thought I could but was just looking for a little backup on my thoughts. Either way though, somebody else might read these posts and get answers that they need. So it's probably a good thing that there were answers for all kinds of scenerios. Thanks all for contributing.

[Frank Stastny]

Originally Posted by TRK3031962

Yes, this is the answer. I'm sorry if I didn't give enough info to begin with. I was really trying to keep it simple. I know all of the other stuff that was posted here about the PDP and the 12 month guarantee and all. I was only concerned whether or not I could change her after the AEP and during the OEP. I thought I could but was just looking for a little backup on my thoughts. Either way though, somebody else might read these posts and get answers that they need. So it's probably a good thing that there were answers for all kinds of scenerios. Thanks all for contributing.

When it comes to all the crap that CMS is dumping on agents there is no question that shouldn't be asked and even answers slightly "off topic" should always to be considered a good thing.

One should never let a day go by without trying to learn something new.

It's comforting to know that we can come here and find someone to bounce questions and thoughts off of. As in having someone to "cover our six".

[retread]

Originally Posted by Frank Stastny

When it comes to all the crap that CMS is dumping on agents there is no question that shouldn't be asked and even answers slightly "off topic" should always to be considered a good thing.

One should never let a day go by without trying to learn something new.

It's comforting to know that we can come here and find someone to bounce questions and thoughts off of. As in having someone to "cover our six".

Yes... good point(s).

Let me leave with the following to ponder: I think of the AEP mainly applying to PDPs and MSAs. We have from Nov 15th to March 31st to sell MAs to over 65s and all year to sell Med Sups and SNPs to all benes, as well as everything to T-65s, no holds barred! I adjust my sales strategies accordingly, adding in other insurance, too.

Knowing the rules for PDPs is the key. Same rules apply to MSAs. By extension, how they apply to MAs during the OEP...