Is There an SEP for This Guy?

wehotex

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Houston, Tex
I recently visited a prospect who was dropped from his MA over 1 year ago due to supposed lack of Part B coverage. He pays a Part B premium check to Medicare every 3 months since he never paid into Social Security and only qualifies due to his wife. He was "late" with one payment. Medicare then informed his MA plan that he dropped his Part B. Prospect claims that he never received the cancellation letter. When I met him recently, he had no LIS, medicaid, chronic condition, not new to the area, etc.; ie, none of the more common SEPs. I'm trying to qualify him now for LIS with Medicare to create a valid SEP.
When I just looked up his info on medicare.gov, I noticed that he has a proposed eff date with another MA!!! I know that the site is not always accurate.

I looked at the list of acceptable SEPs and only found one that I thought might fit. There is one where it picks them up when they are "dropped" by an MA, not the one:"leaving the area". But, it's been well over 1 year since he was dropped by MA. I've NEVER used this particular SEP, so don't know exactly what's involved.
Anybody else had any experience with a prospect like this? Does that SEP work?
 
what the heck is even going on here?

He dropped his part B?

What good is an SEP going to do you with out medicare part B?
 
what the heck is even going on here?

He dropped his part B?

What good is an SEP going to do you with out medicare part B?

He was late in mailing in his Part B pymt to Soc Sec. Soc Sec conveyed to his MA that he had no longer had Part B, thus dropping him from his Plan. He HAS Part B now; he never lost it. The Part B pymt was received after CMS had already advised the MA of lack of Part B.
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what the heck is even going on here?

He dropped his part B?

What good is an SEP going to do you with out medicare part B?

Just talked to the guy again. The agent that he has been dealing with for many years is actually a friend of his, but he thought that the agent moved out of town. He would not tell me who the agent was. The loss of the sale doesn't bother me at all, just want to know which SEP he used. Best I can tell, they phoned CMS and got a special SEP to enroll him for a 5-1-12 eff date. The Wellcare verifier told the man that he would get rx for $1.49-2. Again, this prospect has no LIS.

Even if I enrolled him and went through all of that chatter with 800-medicare, I still would have lost the sale when his original agent returned from out of town.

One of the broker managers once told us that a prospect merely applying for LIS would qualify them for SEP even if they don't really qualify.

Now I'm wondering if that might be true?
 
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One of the broker managers once told us that a prospect merely applying for LIS would qualify them for SEP even if they don't really qualify.

Now I'm wondering if that might be true?[/QUOTE]

The manager that told you that is wrong. Medicare verifies the lis and if they qualify they get reduced drug copays, once that takes place you can then use an sep if needed.
 
One of the broker managers once told us that a prospect merely applying for LIS would qualify them for SEP even if they don't really qualify.

Now I'm wondering if that might be true?

The manager that told you that is wrong. Medicare verifies the lis and if they qualify they get reduced drug copays, once that takes place you can then use an sep if needed.[/QUOTE]

The manager in question had said some other strange things in the past too, so it's not unusual. I have been verifying the LIS before app submission ever since the SEPs started. When the application processors returned an app to me, it was because they didn't have any of the qualifying SEPs after they verified it with their Marx system.
 
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He most likely appealed for a SEP. If he never lost his Part B he should have never been dropped. If he did lose his Part B, I wonder if that opened up another IEP when he picked up Part B again?
 
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