Any Creative Election Code Suggestions For This Client

[yogooglethis]

I enrolled T65 client in a zero dollar MAPD plan for 7/1/13 using the IEP election code.Because of his high income he was assessed a $ 29.90 surcharge for the part D component of his zero dollar premium MAPD plan with UHC and also has to pay $ 272.70 for his part B. Due to the fact he isn't collecting Social Security it can't be deducted automatically. He claims he actually did send the premiums in on time but there was a discrepancy according to CMS and as we know CMS is always right in these type of discrepancies..

Medicare dis enrolled him from the MAPD plan effective 12/31/13 for non payment of his part D premium.We talked with Social Security today and they confirmed that he is paid up on his premiums through 1/1/14 but today the SS office and the carrier said a reinstatement can only be done by CMS and if it is I am pretty sure I will be cut out of the picture but that is beside the point for now.

What I was wondering is if a SEP Trial Period would work here if he wanted to get a Med Supp and a Part D since he enrolled in a MA plan upon T65 less than 12 months ago even though as of 1/1/14 he only has A and B.I know the Med supp is no problem but he is most worried about part D because his rx cost is so high he will be in and out of the gap in 2 months.

Here is what the carriers ( UHC ) election code says about time frame of eligibility for the SEP - TRIAL PERIOD election code:

Begins the month enrolled
into the MA-PD plan for the
first time and extends for 12
months
Ends two months after the
MA-PD disenrollment takes
effect


Looks plausible to me but I am concerned about the issue that he was terminated from plan maters.Of course the carrier won't give you guidance on what code to use and I have never come across this scenario before.

 

[G.Gordon]

Work with Medicare's advance resolution dept to get an "undue hardship" consideration applied for. He made an attempt to pay his premium, cms shows such, glitches in the system caused him to be kicked off. I 've had success with this process.


The sep idea might fool a medigap to issue coverage, but you might need a letter to get GI, then you have the pdp issue, with no sep for pdp enrollment, he's pdp-less and earning a penalty.


IMO, best to fix this by working with cms.

 

[cadylou]

If he can get through underwriting, you can get him the Med Supp anytime. If he needs, GI, you most likely won't get it unless the issue is resolved properly. As G Gordon states, you'd still have a PDP issue looming with penalties attached. Work through the appeals process with CMS. Done properly, it should get resolved. I just requires a little patience.

 

[yogooglethis]

Work with Medicare's advance resolution dept to get an "undue hardship" consideration applied for. He made an attempt to pay his premium, cms shows such, glitches in the system caused him to be kicked off. I 've had success with this process.


The sep idea might fool a medigap to issue coverage, but you might need a letter to get GI, then you have the pdp issue, with no sep for pdp enrollment, he's pdp-less and earning a penalty.


IMO, best to fix this by working with cms.

Thanks just knowing the right buzz words to use like " undue hardship" to get to the next level of escalation when dealing with CMS can make all the difference.I I will try that today

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Work with Medicare's advance resolution dept to get an "undue hardship" consideration applied for. He made an attempt to pay his premium, cms shows such, glitches in the system caused him to be kicked off. I 've had success with this process.


The sep idea might fool a medigap to issue coverage, but you might need a letter to get GI, then you have the pdp issue, with no sep for pdp enrollment, he's pdp-less and earning a penalty.


IMO, best to fix this by working with cms.

Yes the "advance resolution" avenue worked like a charm today.

Something I learned on the call to CMS today is the reason he was dis enrolled for late part D surcharge was because he sent in his payment for the 272.00 part B and the 29.00 part D surcharge just a day or two late and it's CMS protocal that when the payment comes in past the due date the 272.00 and 29.00 are applied to the part B IRMA component of the bill and the part D component shows as not paid for the month.So make sure you let you high income earners not collecting SS know to send payments on time or sign up for the EZ pay.

 

[G.Gordon]

Good deal, love it when client's needs are met.