Humana and Medicare Guidelines

[yogooglethis]

That's "ICEP", not "IEP".

I looked at an election code booklet today and it says this is NOT an ICEP for mapd enrollment at all and there is NO SEP for a mapd . Furthermore the only SEP for a part D enrollment for a 7/1 effective date following the GEP is if:

"Not entitled to premium-free Part A & enrolled in Part B during the GEP for Part B"


I have never tried to submit a PDP for a 7/1 but I used ICEP for mapd applications for a 7/1 effective following the GEP a few times and never any problem. I guess ignorance is bliss

 

[WCMason]

I enrolled several GEP eligibles into an MAPD in June for a 7/1 start using ICEP as their election. See bottom of page 3 for description of eligibility per CMS:

http://www.medicare.gov/Pubs/pdf/11219.pdf

I should add that the only trouble I had was trying to get one of my clients--GEP Part B enrollee--into a WellCare PDP. Had two reps there and a supervisor tell me there was no valid election and they had never heard of GEP allowing a 4/1 to 6/30 PDP election. The denied the enrollment. So instead had CMS take enrollment on the phone.

 

[yogooglethis]

I enrolled several GEP eligibles into an MAPD in June for a 7/1 start using ICEP as their election. See bottom of page 3 for description of eligibility per CMS:

http://www.medicare.gov/Pubs/pdf/11219.pdf

I should add that the only trouble I had was trying to get one of my clients--GEP Part B enrollee--into a WellCare PDP. Had two reps there and a supervisor tell me there was no valid election and they had never heard of GEP allowing a 4/1 to 6/30 PDP election. The denied the enrollment. So instead had CMS take enrollment on the phone.

Good find.That's funny because it contradicts what some of the big carriers say in their election period booklets. Come to think of it I may have gone to medicare.gov at one point to find this enrollment opportunity just like I had to find out that getting out of jail/prison is also a SEP not mentioned in some of the carriers election code booklets ( cherry picking?)

 

[BobbyMcGee]

You may have hit on something. Maybe I'll start stalking old guys getting out of Starke with MAPD's.

 

[txagent41]

I am resurrecting this thread because it gets even crazier!

I fix the app, going from IEP to SEP-GEP. Medicare rejects it!!!!! Or at least Humana says it's rejected.

Humana says that she can only use SEP-GEP if she is paying for A. If she gets A free, then she has to wait until AEP to get her PDP.

It doesn't make any sense to me. You would think that when you get your B, you would have a chance to get D, right? You are already being penalized for messing up, to make you wait until AEP is just rubbing salt in the wound.

Nope. Her Part D IEP expired 3 months after going on Part A. Given that she didn't have creditable drug coverage, when she went on Part B is irrelevant.

 

[WCMason]

Nope. Her Part D IEP expired 3 months after going on Part A. Given that she didn't have creditable drug coverage, when she went on Part B is irrelevant.

The IEP expired. The ICEP had not at that time. Part B enrollment is relevant. See the CMS publication posted earlier in this thread.

 

[txagent41]

The IEP expired. The ICEP had not at that time. Part B enrollment is relevant. See the CMS publication posted earlier in this thread.

I had no idea that SEP existed, and have never seen it on an app. Like Cindy said though, I guess it makes sense for them not to have to wait until the AEP to join a PDP.

What's the point to allowing it only to people that have to pay for Part A?

 

[jbage007]

Just been through the ringer with one of these. Here's how it panned out for my client.

He late enrolled into Part B by two years. This meant he only was able to enroll in Part B via General Enrollment Period. Coverage starts July 1 regardless of when you enroll in that GEP.

NOT eligible for any PDP for July 1 - ONLY MA or MAPD due to fact that he does not pay for Part A.

This is an ICEP for MA or MAPD only (because it is his initial enrollment period - one time only).

Client only wanted Med Supp, however, so he needed a PDP plan. Too bad. Can't do that at all - must wait until AEP to pick up a PDP plan.

So that's what he did - went with Med Supp and no Rx plan (he has no Rx drugs at all, thank goodness).

Also was entitled to "open enrollment" for Med Supp, i.e., guaranteed issue.

Really strange as to why someone in this position would NOT be able to purchase stand alone PDP for eff. date of July 1. What difference it makes if they pay for Part A - only the bureaucrats running CMS would know the answer to that one, and I'd pay a pretty penny to anyone who can find someone at CMS who actually understands the rationale for this rule.

 

[WCMason]

Just been through the ringer with one of these. Here's how it panned out for my client. He late enrolled into Part B by two years. This meant he only was able to enroll in Part B via General Enrollment Period. Coverage starts July 1 regardless of when you enroll in that GEP. NOT eligible for any PDP for July 1 - ONLY MA or MAPD due to fact that he does not pay for Part A. This is an ICEP for MA or MAPD only (because it is his initial enrollment period - one time only). Client only wanted Med Supp, however, so he needed a PDP plan. Too bad. Can't do that at all - must wait until AEP to pick up a PDP plan. So that's what he did - went with Med Supp and no Rx plan (he has no Rx drugs at all, thank goodness). Also was entitled to "open enrollment" for Med Supp, i.e., guaranteed issue. Really strange as to why someone in this position would NOT be able to purchase stand alone PDP for eff. date of July 1. What difference it makes if they pay for Part A - only the bureaucrats running CMS would know the answer to that one, and I'd pay a pretty penny to anyone who can find someone at CMS who actually understands the rationale for this rule.

I recommend reading the Medicare Prescription Drug Manual. Your client could have a Part D plan now if you had. Part A is not required for PDP eligibility. Every place you see eligibility described it's with an "and/or." As in A and/or B. Like this:

20.1 - Entitlement to Medicare Parts A and/or B To be eligible for Part D and to enroll in a PDP, an individual must be entitled to Medicare Part A or enrolled in Part B as of the effective date of coverage under the PDP. That's from the previously mentioned manual.

Here is a link to it: http://www.cms.gov/Medicare/Eligibi...P-Enrollment-and-Disenrollment-Guidance-r.pdf

One more note: it's the MA/MAPD that requires Part A. How one has Part A--paid or premium-free--is not relevant, but there is no ICEP for an MA/MAPD without A.

 

[jbage007]

I recommend reading the Medicare Prescription Drug Manual. Your client could have a Part D plan now if you had. Part A is not required for PDP eligibility....

Look at page 19 on that link you provided. You'll find this section:

There are 3 periods in which an individual may enroll in and/or disenroll from a PDP:
• The Initial Enrollment Period for Part D (IEP for Part D);
• The Annual Election Period (AEP);
• All Special Enrollment Periods (SEP)

Note that first becoming eligible for Part A creates an IEP for Part D. You only get ONE IEP. Thus, none of those 3 options apply to a July 1 enrollment into Part B via GEP because that does not qualify as any of those 3 options above.

I believe this is why the PDP enrollment for July 1 is not allowed - because the client COULD have enrolled when first becoming eligible for Part A, and chose not to do so. Further, this is not an AEP (duh) nor is it an SEP! That last part is what is confusing too because people mistakenly believe that the July 1 entry into Part B is allowed through an SEP but that is not the case.

So thanks for that link but it actually explains exactly why the July 1 PDP is not allowed.