It’s that time of year again when PACE/PACENET are sending their enrollees letters about changing their PDP. We contacted PACE and found out the following: If the client is currently enrolled in a MAPD they should not receive a letter however PACE does not guarantee that a MAPD client would not receive a letter. This means you will probably want to contact your clients that are on PACE and see if they received a letter. Clients that are enrolled in a Stand Alone PDP will receive that letter and you will want to advise them to contact PACE to be removed from the change list.
Here is the letter that PACE/PACENET sent to their clients: pace-letter
Amy:
PFFS member (MA only) can enroll in a PDP. This is not true if the MA only is HMO/PPO, so, while they were wrong, they had some basis for being confused.
If you click on the PACE link in the original blog posting, you will find the 2009 partner plans!
Brenda,
who are the partner plans with?
amy
I got invited to a PACE training seminar this all but couldn’t attend so they sent me te slides. They have not assigned him a PDP partner plan and told me they won’t because he is in an MA plan (PFFS).
I think because he isn’t enrolled in a PDP he will have to pay that premium each month, whereas if I signed him up in a partner plan that would be waived.
The person I talked to at PACE seemed to feel that if I tried to enroll him in a PDP it would mess up his MA enrollment….but they said it sounded like I knew more than they did !
The best MA plan for him is with Secure Horizons (PFFS) and doesn’t have a drug plan with it so I think I will look into the partner plans and sign him up.
Did not know that about the Opt Out Period End Date. Thanks!!!
I was under the impression that if someone is in an HMO or PPO that Pace/PaceNet would not offer them a Part D but I can see with all the elections and keeping track of plans that an offer could go out.
When we visit people on Pace/PaceNet they always question the auto enrollments and aren’t sure what they have. I will say that for most part the people we have dealt with at PACE have been friendly, helpful and courteous. But the Medicare Beneficiaries that have been auto assigned and have not had discussions with agents do not understand from just the direct mail pieces they receive on this. So calling PACE direct and/or reviewing with an agent is usually necessary.
If MA is a PFFS and I write PACE partner plans I do it. I rep two of the partner plans and it has worked well for us so far. I normally only do this when someone is first coming into an MA and they are also applying and/or just became eligible for PACE so no auto assignment is in play or has happened yet. So if I write someone an MA and it appears through our discussions that they would be eligible for PACE/Pacenet, we advise them of how to apply and when we enroll the MA, we guide them to choose a partner plan PDP so they are already in it when and if they are approved for PACE/Pacenet. They appreciate it and they receive a full review/presentation of the plan that will be their partner plan.
Amy:
Probably not is the short answer. Here is the long answer:
What type of MA? If it’s a PFFS, then they can be enrolled in one of the PACENET partner PDP’s with no problems.
If it’s an HMO or PPO, then it might be possible to do better with an MAPD, but only if the plan you chose for him has an MAPD version which coordinates with PaceNET. I added the PACE/PACENET website link above which shows the partnering plans.
If an MAPD plan coordinates with PACENET, then PACENET pays the portion of the premium attributable to the Drug portion and the Drug Premium becomes the premium at the pharmacy. This might be a worthwhile endeavor if the plan had a $0 co-pay for generics?
In my opinion, probably more aggrevation than it’s worth, but perhaps some others could weigh in.
With the MA only plan and PACENET, there will be a $26.59 monthly premium at the pharmacy and a $8 Generic and $15 Brand co-pay with a complete formulary and no doughnut hole.
In summary, if MA is PFFS, let them get enrolled in a PDP by PACENET. If MA is HMO or PPO, tell them to OPT OUT if PACENET tries to assign them to a plan.
THE OPT OUT PERIOD ENDS ON NOVEMBER 21, 2008!!!
I have a client on just an MA and PACENET, should I advise him to enroll in an MAPD?