Is Medicare Holding Back on Us All the Available SEPs for People with VA Benefits ?

[yogooglethis]

I signed up a man with VA benefits for a Med supp back in 10/12 to be effective 1/1/13.This guy was enrolled in a MAPD but was not going to take a stand alone part D for 2013 if he had to pay for it.I stressed to client the importance of calling carrier to dis enroll from the MAPD plan after he is approved for Med Supp since it won't happen automatically because he wasn't signing for a part D plan.

Client said he called the carrier in November 2012 and requested to be dis enrolled but was not dis enrolled and didn't find this out until March.I tell him the only possible way to reverse this is to call Medicare and have them escalate it. I was on the 3 way call today to Medicare with client today and call did get escalated to a Medicare benefits specialist who informed us that he can drop his MAPD plan any time because he has VA benefits and he dis enrolled him from the MAPD plan as 5/1/13.

I was just being silent on the 3 way call and was only going to speak up if client said something that was going to implicate me in any wrong doing or if client left something out that was important when stating his case.I would have liked to have asked the Medicare specialist what that SEP code was he was using for people with VA benefits and if it's good for enrolling and dis enrolling.

It made me look dumb in front of client because I insisted there was not another way of getting him off the MAPD plan.I wish we could see the comprehensive list of SEPs that Medicare allows.I discovered that there are some SEPs listed on medicare.gov that are not in the carriers election code list.I had a referral from a dude that had got out of prison and at first i told him he can't enroll until the AEP but found out on medicare.gov he was eligible for a SEP- change of residence.

And why wouldn't the carrier acknowledge or know about this SEP when client called in March to tell them he didn't want to be on MAPD plan?

 

[AllGold]

I see the prison/change of residence thing as being a routine SEP.

As for the VA thing, this is one of the SEPs: "You have or are enrolling in other drug coverage as good as Medicare prescription drug coverage (like TRICARE or VA coverage)."

Even without that SEP, just keep in mind that when you talk to Medicare directly, they can do whatever they want. If the rep or supervisor wants to make an exception they can. I don't know how they handle that internally but it doesn't really matter to us because we can't do it anyway. Medicare has the "exceptional circumstance" SEP. Whether they use that as a catch-all or they have other internal/secret SEPs for different purposes doesn't make much difference to us since it can only happen through Medicare.

 

[AngelBand]

The bebeficiary must use the term "credible coverage" and that will disenroll a Vet from a MAPD or Part D through Medicare.

Many times I will insrtuct them to say to the first rep on the phone, "with all due respect I need to speak to a supervisor".

 

[Norwayguy]

I always love reading these posts...It give me good insight into the future of ObammieCare....You must enroll during an enrollment period unless you call Medicare and they waive all thier rules on a discretionary basis meaning some people are treated differently than others.

 

[SportsNut]

I always love reading these posts...It give me good insight into the future of ObammieCare....You must enroll during an enrollment period unless you call Medicare and they waive all thier rules on a discretionary basis meaning some people are treated differently than others.

They may need to place you on hold to check your voter registration prior to rendering a decision.

 

[yogooglethis]

I see the prison/change of residence thing as being a routine SEP.

As for the VA thing, this is one of the SEPs: "You have or are enrolling in other drug coverage as good as Medicare prescription drug coverage (like TRICARE or VA coverage)."

Even without that SEP, just keep in mind that when you talk to Medicare directly, they can do whatever they want. If the rep or supervisor wants to make an exception they can. I don't know how they handle that internally but it doesn't really matter to us because we can't do it anyway. Medicare has the "exceptional circumstance" SEP. Whether they use that as a catch-all or they have other internal/secret SEPs for different purposes doesn't make much difference to us since it can only happen through Medicare.

I know that if a person activates VA benefits they had been eligible for but just never applied for it does create a SEP but this guy had VA all along

The way the " Medicare Benefits Specialist" said it on phone it sounded like having VA benefits was a routine well known SEP for enrolling or dis enrolling in a MAPD or PDP. If it wasn't you would think the specialist would have acknowledge to client that this was a inside CMS "double secret SEP " that the agent and the carrier wouldn't be privy to.It just made me look bad in front of the client that I didn't know about this VA SEP code or have the special powers to use it to save them all the aggravation.
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The bebeficiary must use the term "credible coverage" and that will disenroll a Vet from a MAPD or Part D through Medicare.

Many times I will insrtuct them to say to the first rep on the phone, "with all due respect I need to speak to a supervisor".

So this a SEP that only can be used if they call CMS? Do you know if it can be use ti enroll in a MAPD as well? Thats funny because when the client called CMS the first time they didn't offer this as a solution.It was only when they called CMS and said they wanted to escalate did they acknowledge it.

 

[AllGold]

The SEP says "You have or are enrolling in other drug coverage as good as Medicare prescription drug coverage (like TRICARE or VA coverage).

 

[yogooglethis]

The SEP says "You have or are enrolling in other drug coverage as good as Medicare prescription drug coverage (like TRICARE or VA coverage).

But in this case they were already enrolled in VA.They don't drop or lose VA if they enroll in PDP or MAPD.

Just curious what is the SEP you are referring to called?

 

[openmindedone]

Five months worth of premiums.

Will you give him a refund?

 

[AllGold]

Just curious what is the SEP you are referring to called?

Off the top of my head, I don't know what it's called--it doesn't say. It came from this: http://www.medicare.gov/Pubs/pdf/11219.pdf