Humana and Medicare Guidelines

[WCMason]

I see your problem now. You think some random PDF file posted on the MEDICARE website is some kind of mandatory rule issued by CMS. You actually did publish CMS guidelines earlier and I went in and clearly showed you where the language is that controls this issue but for whatever reason you don't want to read it or you simply don't want to believe it. You'd rather have your clients rely on some random PDF file posted on the MEDICARE website. When you think about it, the (actual CMS) rule makes sense. When someone first becomes eligible for Part A, they are entitled to enroll in a PDP AT THAT TIME. If they opt not to do so, then their one and only INITIAL ENROLLMENT opportunity passes them by. After that, they can only enroll in a PDP plan during AEP, just like everyone else, or unless a SEP applies, where here it clearly does not. I am done discussing this with you because you refuse to read the actual CMS guidelines and/or the Humana Job Aid which tracks the CMS guidelines. You just want to issue your own interpretation based on your own misunderstanding or inadequate research ("hey I found a PDF file, wooppie"). Just be sure your E&O stays up to date. --- By the way, you go on and on about how pitiful and sad it is that people have to go (another - although you leave that word out) six months without a drug plan and they will have an even larger late enrollment penalty. Well guess what bubba? That is their OWN CHOICE. They had the option to enroll in a stand alone part D plan when they became eligible for Part A. They passed it up. Now they suffer the consequences. Too bad. Too sad. I'm not crying any tears for those people who opt to try and bamboozle the system by not purchasing a drug plan when they first could just because they don't want to pay the premiums. And one final big FYI - if those folks really wanted drug coverage in this situation, all they have to do is enroll in an MAPD for July 1. Problem solved. If they don't live in an area where any viable MAPD plans are marketed, again, too bad, too sad. Play by the rules or suffer the consequences.

Sounds like this settles it. I'll use this ICEP, you'll tell people they can't.

 

[jbage007]

Sounds like this settles it. I'll use this ICEP, you'll tell people they can't.

It's not even an ICEP dude. That is reserved solely for MAPD plans, not PDP.

oh is that what you mean - you finally saw the light and plan to write an MAPD plan for these folks?

ok, great because that works but submitting an application for a stand alone PDP plan for July 1 eff. date for someone who late enrolled in Part B via General Election Period is blatantly forbidden - BY CMS - assuming that person already qualified for or has in place Part A (at no cost)

Not sure what kind of training you folks have had in this Part C/Part D world, but it is spurious at best.



seriously dude - stop responding to this thread. let it go. you're wrong and you're not changing anyone's mind. so just give it a rest already.

 

[policy doctor]

You're gonna learn, JBAGE, like some of us already did...that you can't illuminate some people. LOL

 

[WCMason]

You're gonna learn, JBAGE, like some of us already did...that you can't illuminate some people. LOL

Absolutely correct. Those who have used a valid election period to successfully enroll people into a PDP tend to be immune to illumination by those who claim it can't be done.

 

[ser93boy]

So, I've been around the block a couple of times with PDP and MAPD's. I'm pretty sure I have the basics down. Humana just through a screwball at me.

Client misses her window to sign up for B at 65- no real reason, forgot or something. I told her to get her buns to Social Security back in January to grab the general enrollment. Explained penalties, etc. Easy.

Saw her last week to get her set up for a July 1 start date. Med Supp- done. PDP- pending. Pending? WTH? So I call Humana this morning to find out what I did wrong. (No assistant and 45 minutes I did not have on the phone) They told me I chose the wrong election period. I used IEP- which, on the app says it's the only PDP initial election choice. I'm dumb, but even I could figure that out. CSR then begins to tell me that because her A & B dates don't match and she does not have an SEP she can therefore only sign up for an MAPD. I told her to prove it.

She places me on hold to get me "proof". While on hold, I find the Medicare publication that says if you have a general enrollment you can sign up for either a PDP or MAPD starting 7/1. Took me 30 seconds and Google. She picks up and says, it's right here in the election period grid, made by Humana, on the Humana website. I said- it's wrong. I have the Medicare grid on the Medicare website, which are the rules that Humana need to follow. Send it up the chain and fix it. She really truly did not believe me. I've seen some crazy stuff, but you'd think that the carriers would have the basics done properly.

Anyone else have this problem? Should I prepare for battle?

I now have the same exact issue with the same exact carrier.
I used the SEP GEP election period and it was rejected by the carrier.
Did you ever get this resolved and how?

 

[vic120]

I don't know I was sure I could use an EP to enroll during GEP for PDP, However last year I had one declined and this year from humana, and this year I had several from group and got Part B first time, And I was told by AARP that they only EP that can be used is loss of group because they were eligible to Enroll in PDP with part A only so there is no IEP or ICEP.Although I am 80 % sure I used to be able to and had enrolled during GEP before

 

[TwoCents]

I don't know I was sure I could use an EP to enroll during GEP for PDP, However last year I had one declined and this year from humana, and this year I had several from group and got Part B first time, And I was told by AARP that they only EP that can be used is loss of group because they were eligible to Enroll in PDP with part A only so there is no IEP or ICEP.Although I am 80 % sure I used to be able to and had enrolled during GEP before

From the Medicare PDP guidelines:
6. SEP for Individuals Who Enroll in Part B during the Part B General Enrollment Period (GEP) – An SEP will be provided to individuals who are not entitled to premium free Part A and who enroll in Part B during the General Enrollment Period for Part B (January – March) for an effective date of July 1st. The SEP will begin April 1st and end June 30th, with an effective date of July 1st.

The key here is that the SEP is not available to those who are receiving Part A premium-free which your clients likely are. Most probably started Part A on time since it's difficult to decline and would be free so unless they run into a coordination of benefits problem, no foul, no harm. But along with starting that Part A, Part D also starts which means the IEP clock is ticking for a PDP. Because that Part D entitlement date doesn't reset when they enroll into Part B, there is no IEP available; only the ICEP for an MA/MAPD enrollment.

 

[ser93boy]

She does not pay a part A premium, and she refuses to get an MAPD. She does not take any meds, but took a PDP because she does not want to risk a possible part D LEP in the future. With that said, does she risk a late enrollment going back to age 65 when she first got part A? She is 68 now.

 

[TwoCents]

She does not pay a part A premium, and she refuses to get an MAPD. She does not take any meds, but took a PDP because she does not want to risk a possible part D LEP in the future. With that said, does she risk a late enrollment going back to age 65 when she first got part A? She is 68 now.

Yes, very likely she'll face an LEP unless she attests to having some form of creditable coverage.