Would This Be CMS Compliant?

[wehotex]

I have a list of MA plan mbs who were enrolled by another rep no longer in the business. If I door knock to offer Medigap due to their MA plan not renewing, would this be OK? One of the stips of the non-renewing letter from their current MA indicates that they may now qualify for a Medi-Gap with guaranteed issue. These ppl are now on a Special Needs Plan with $0 copays, but will soon have to select a Plan with a lot of copays or a Medigap. I would still follow the 48 hr rule (or longer) if they tell me that they cannot afford a Med supp.

 

[tins]

I have a list of MA plan mbs who were enrolled by another rep no longer in the business. If I door knock to offer Medigap due to their MA plan not renewing, would this be OK? One of the stips of the non-renewing letter from their current MA indicates that they may now qualify for a Medi-Gap with guaranteed issue. These ppl are now on a Special Needs Plan with $0 copays, but will soon have to select a Plan with a lot of copays or a Medigap. I would still follow the 48 hr rule (or longer) if they tell me that they cannot afford a Med supp.

They aren't duals are they? If so, let them go back to Medicare and Medicaid alone. If it is a chronic conditions SNP, I'd imagine you'd have lots of success offering to get them a G.I. med supp.
Pretty sure you are okay with CMS on this one. If you aren't, maybe the helping people with their lives will get you over the guilt.

 

[Todd King]

CMS is a very understanding and forgiving organization. You don't think they expect you to follow ALL their rules do you?

After all, they don't know all the rules from one day to the next, how could they expect you to?

They don't expect you to....do they? Do they?

 

[wehotex]

They aren't duals are they? If so, let them go back to Medicare and Medicaid alone. If it is a chronic conditions SNP, I'd imagine you'd have lots of success offering to get them a G.I. med supp.
Pretty sure you are okay with CMS on this one. If you aren't, maybe the helping people with their lives will get you over the guilt.

They are only partial duals, not FULL duals. Going back to medicare-medicaid is not an option.

 

[MrMack]

Got this e-mail today....You may have to wait until Dec. 8

Medicare Advantage and Part D
enrollment alert ​

Question: When is the Special Election Period (SEP) for members of Medicare Advantage (MA) plans who will be affected by service area reductions or plan non-renewal effective December 31, 2011?

Answer: In prior years, an early SEP permitted agents to accept enrollments in October. However, the Centers for Medicare & Medicaid Services (CMS) has issued new MA Enrollment Guidance. In order to provide sufficient time for members to evaluate their options, the SEP begins December 8, 2011 and ends on February 29, 2012.

Please note the following effective dates:

• Enrollment requests received from December 8 through December 31, 2011 will have an effective date of January 1, 2012.
• Enrollment requests received in January will have an effective date of February 1, 2012.

Enrollment requests received in February will have an
effective date of March 1, 2012.​

 

[Josh]

Without reading anything but the title, I'm going to say no. Now I will go up and read.
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After reading it, here is the problem you're going to have:

CMS is following the tried and true "if it looks like a witch and it floats like a witch, then it's a witch" judge and jury system. What you're saying is you'd like to skirt the law, but prima facia, you're looking to knock doors and sell an MA plan. Are you actually breaking any rules? Probably not, but if you got caught you probably would be found guilty.

"Mrs. Jones, when did the agent stop by?"
"He knocked on my door last week and talked to me about a Medicare Advantage plan and is coming back later to enroll me because he has a different plan that would be better for me so I get to keep my Medicare Advantage benefit".

Slice it up any way you like it, but even if you're right, I don't think anyone is going to buy your story.

 

[tins]

Got this e-mail today....You may have to wait until Dec. 8

No need to wait until Dec. 8th. Can get them switched beginning Oct. 15th during AEP.
Should any of those people want to change again, or didn't get it done in time. They have another SEP from Dec. 8th until Feb. 29.
(Also, since they're partial duals and have a LIS, they have a year round SEP.)
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They are only partial duals, not FULL duals. Going back to medicare-medicaid is not an option.

Find out what kind of LIS they have. Depending on their level and spend down, some may be better off picking up a med. supp. Others, may be better off going back to Medicare/Medicaid. Others, may be better off with another MA, with the copays.
Work them, fact find. Don't let CMS scare you away from helping people!