New PDP SEP Announced 8/30/14 for 2015

[WCMason]

From the Medicare Prescription Drug Manual update 8/30/2014:

I. SEP to enroll in a PDP - MA enrollees using the "SEP for Significant Change in Provider Network" to disenroll from an MA Plan - MA enrollees using the "SEP for Significant Change in Provider Network" to disenroll from an MA plan may request enrollment in a PDP. This coordinating SEP begins the month the individual is notified of the network change and continues for an additional two months. This SEP permits one enrollment and ends when the individual has enrolled in the PDP. An individual may use this SEP to request enrollment in a PDP subsequent to having submitted a disenrollment to the MA plan or may simply request enrollment in the PDP, resulting in automatic disenrollment from the MA plan. Enrollment in the PDP is effective the first day of the month after the plan sponsor receives the enrollment request.

I'm eager to see how they define "significant change."

Here is a link to the publication. This SEP is on page 33.

http://www.cms.gov/Medicare/Eligibi...PDP-Enrollment-and-Disenrollment-Guidance.pdf

 

[jacobtn]

From the Medicare Prescription Drug Manual update 8/30/2014:

I. SEP to enroll in a PDP - MA enrollees using the "SEP for Significant Change in Provider Network" to disenroll from an MA Plan - MA enrollees using the "SEP for Significant Change in Provider Network" to disenroll from an MA plan may request enrollment in a PDP. This coordinating SEP begins the month the individual is notified of the network change and continues for an additional two months. This SEP permits one enrollment and ends when the individual has enrolled in the PDP. An individual may use this SEP to request enrollment in a PDP subsequent to having submitted a disenrollment to the MA plan or may simply request enrollment in the PDP, resulting in automatic disenrollment from the MA plan. Enrollment in the PDP is effective the first day of the month after the plan sponsor receives the enrollment request.

I'm eager to see how they define "significant change."

Here is a link to the publication. This SEP is on page 33.

http://www.cms.gov/Medicare/Eligibi...PDP-Enrollment-and-Disenrollment-Guidance.pdf

Can they enroll in a MA as well using this?

 

[WCMason]

Can they enroll in a MA as well using this?

Doesn't say. Also doesn't say whether this will create a GI opportunity for a med supp. Clarification will likely follow. Without one of those the SEP may not be that helpful for many.

 

[axeman462]

From the Medicare Prescription Drug Manual update 8/30/2014:

I. SEP to enroll in a PDP - MA enrollees using the "SEP for Significant Change in Provider Network" to disenroll from an MA Plan - MA enrollees using the "SEP for Significant Change in Provider Network" to disenroll from an MA plan may request enrollment in a PDP. This coordinating SEP begins the month the individual is notified of the network change and continues for an additional two months. This SEP permits one enrollment and ends when the individual has enrolled in the PDP. An individual may use this SEP to request enrollment in a PDP subsequent to having submitted a disenrollment to the MA plan or may simply request enrollment in the PDP, resulting in automatic disenrollment from the MA plan. Enrollment in the PDP is effective the first day of the month after the plan sponsor receives the enrollment request.

I'm eager to see how they define "significant change."

Here is a link to the publication. This SEP is on page 33.

http://www.cms.gov/Medicare/Eligibi...PDP-Enrollment-and-Disenrollment-Guidance.pdf

My guess is if your PCP is dropped from the network

 

[WCMason]

My guess is if your PCP is dropped from the network

If "significant" refers to the beneficiary then yes. If it refers to the plan, not so much.

 

[TwoCents]

From the Medicare Prescription Drug Manual update 8/30/2014:

I. SEP to enroll in a PDP - MA enrollees using the "SEP for Significant Change in Provider Network" to disenroll from an MA Plan - MA enrollees using the "SEP for Significant Change in Provider Network" to disenroll from an MA plan may request enrollment in a PDP. This coordinating SEP begins the month the individual is notified of the network change and continues for an additional two months. This SEP permits one enrollment and ends when the individual has enrolled in the PDP. An individual may use this SEP to request enrollment in a PDP subsequent to having submitted a disenrollment to the MA plan or may simply request enrollment in the PDP, resulting in automatic disenrollment from the MA plan. Enrollment in the PDP is effective the first day of the month after the plan sponsor receives the enrollment request.

I'm eager to see how they define "significant change."

Here is a link to the publication. This SEP is on page 33.


A little information is a dangerous thing. The OP referred to the PDP manual. As one would expect there is also an MA manual. Don't dream of writing applications with this SEP yet. Sorry can't post URLs yet, but if you can't find it yourself, well, that's on you.

 

[MedSuppPro]

This is great news. This is great news.

 

[vic120]

My guess is if your PCP is dropped from the network

My guess would be Significant more then PCP

Probable many docs dropped like with UHC in FL last year

 

[TwoCents]

From the MA Guide:
30.4.6 – SEP for Significant Change in Provider Network
An SEP exists for situations in which CMS determines that changes to an MA plan’s provider network that occur outside the course of routine contract initiation and renewal cycles are considered significant based on the affect or potential to affect, current plan enrollees.
CMS will establish an SEP, on a case by case basis, if it determines a network change to be significant. The SEP will be in effect once CMS makes its determination and enrollees have been notified. The SEP begins the month the individual is notified of the network change and continues for an additional two months. Enrollment in the new plan is effective the first day of the month after the plan receives the enrollment request.
The scope of the SEP will be determined by CMS, and it may include enrollees who have been affected, or who may be affected, by the network change. Individuals eligible for the SEP may disenroll from the MA plan and elect Original Medicare or another MA plan, including an MA-PD even if they did not have prescription drug coverage previously. CMS will provide specific instructions directly to the affected organization, including instructions on required beneficiary notifications and information to be provided to affected beneficiaries regarding other enrollment options, if applicable.

 

[axeman462]

My guess would be Significant more then PCP

Probable many docs dropped like with UHC in FL last year

im guessing thats why they made this sep