Humana and Medicare Guidelines

[insuranceconceptscindy]

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?

 

[GreenSky]

So, I've been around the block a couple of times

We all suspected as much.

I have a very helpful contact with Humana if you need it. Let me know via email.

Rick

 

[TwoCents]

OK, so your client's A & B dates do not match. IEP is based on Part D -- even though it's not printed on a Medicare ID card, everyone has a Part D start date. For your client it's probably the same as her Part A and she did miss IEP. To enroll her into a PDP the application should have been written with the "SEP for Individuals Who Enroll In Part B during the Part B General Enrollment Period."

 

[vic120]

They said you can enroll MAPD during this period?

Because I just lost one of those

I was on the app when I pulled out the election period booklet
and under Enrolled into Part
B during the Part B
General Enrollment
Period (GEP)

shows Not Applicable for Medicare Advantage Plans


Is this misinformation?

 

[TwoCents]

They said you can enroll MAPD during this period?

Because I just lost one of those

I was on the app when I pulled out the election period booklet
and under Enrolled into Part
B during the Part B
General Enrollment
Period (GEP)

shows Not Applicable for Medicare Advantage Plans


Is this misinformation?

For anyone enrolled into Part B during the GEP their Part B start date would be 7/1. That would put the client into an ICEP (distinctive from an IEP) which would last from 4/1 to 6/30. The ICEP could be used for an MA or MAPD. So the application could be written during that window for a 7/1 start date assuming nothing else is going on with the entitlement.

 

[vic120]

For anyone enrolled into Part B during the GEP their Part B start date would be 7/1. That would put the client into an ICEP (distinctive from an IEP) which would last from 4/1 to 6/30. The ICEP could be used for an MA or MAPD. So the application could be written during that window for a 7/1 start date assuming nothing else is going on with the entitlement.

Wow Just last week let one go

I was on app at the time too

I got this right from the UHC EP cheat sheet

I mean I thought It was a valid EP so I didn't even check till I need to put down EP

Then when I saw Not Applicable for Medicare Advantage Plans

I tried unsuccessfully to qualify client for state assistance
and lost the deal

guess still need to pay to go to school from time to time

 

[insuranceconceptscindy]

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.

 

[BobbyMcGee]

http://www.allianceforaging.org/wp-content/uploads/Special-Enrollment-Period1.pdf

 

[wehotex]

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?

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

 

[insuranceconceptscindy]

Thank you so much BobbyMcgee! That is the first time I've seen the rule in writing. It doesn't make it any less unfair, but it's nice to see it on paper.