There are over 400,000 Medicare Beneficiaries who will be losing their Medicare Advantage Private Fee for Service plans on January 1st, 2010. Also, there will likely be more “service area reductions” announced in the coming weeks.
Did you know that you can write a Medicare Advantage plan for these individuals for a January 1st, 2010 effective date by using a Special Election period? The SEP begins on October 1st, 2009.
If you have clients who are losing their Medicare Advantage plans (especially PFFS), you will want to be ready by October 1st to start moving these clients into alternate Medicare Advantage plans, or into Medicare Supplement plans. If the MA plan included prescription drugs, you can use the SEP to write a stand alone Part D plan (with a Medicare Supplement or stand alone PFFS plan for 2010).
This is NOT an AEP enrollment, so when you take the enrollment, you will want to mark the form as an SEP.
Here is a page I designed which reviews this SEP as well as other common SEP’s!!
Could someone tell the names of all of the companies that are pulling out of PFFS this year?
Did the rules recently change? Humana and Coventry sent out notices that they will not be notifying the beneficiaries until the end of October. Not 90 days before the plan leaves…
Is this SEP actually going to take place? I can’t find it anywhere on the CMS website. Just a lot of people talking about it.
Thanks
Here is the documentation of the SEP. You can click on the link for Chapter 2 enrollment guidelines. I’ve paraphrased on the page, as well: http://ritterim.pbworks.com/Medicare-Advantage-About-Medicare-Advantage-Enrollment-Periods-Special-Election-Period
I got the following from Coventry:
September 28, 2009
Some important compliance notes:
Per section 40.9 of the CMS marketing guidelines: “Plan sponsors may market directly to beneficiaries of former Medicare plans that have chosen not to renew their contracts as long as the marketing does not begin until after the date the beneficiary has received the plan sponsor’s non-renewal letter.”
But if your Coventry PFFS client calls you and has their notification letter in-hand, you could write them over to a Coventry CCP right away–but only if you’re certified to sell Coventry CCP before an application is submitted.
The Coventry notification letter will be sent to members in October and will be in members’ hands by no later than October 28.
Remember, no proactive outreach marketing can begin until October 28!
Questions? Check out our PFFS to CCP Marketing Strategy Tool Kit:
can you help me? I want to get my mother out of secure horizons hmo and into original medicare with with a supplemental so that I can keep her alive. She is 89. How do I do that?
If your mother is in Secure Horizons her Medicare Advantage plan probably isn’t being discontinued. If, by chance, it is discontinued, your mother will get a letter that says she has “guaranteed issue” for a Medicare Supplement. This would mean that she could be enrolled in a Medicare Supplement with no health questions asked.
At 89, if she is in poor health and has been in and out of the hospital, a Medicare Supplement would be her best coverage – though the monthly premium could be $200 per month. However, you may be finding that her $0/month Medicare Advantage plan is costing $500 or $1,000 per month in “co-pays” for hospital stays, ambulance, and specialist visits.
Even if your mother’s Medicare Advantage plan is not being cancelled, she can go back to Medicare and get a Medicare Supplement. AARP will accept her for a monthly premium of $258.70 – even with pre-existing conditions.
This may seem a high price to pay, but with a plan F Medicare Supplement, she would pay $258.70/month an would have no co-pays for doctor visits, hospital stays, ambulance, etc. This is because Medicare will pay it’s part and the Medicare Supplement will pay the balance.
However, your mother can’t leave her Medicare Advantage plan until January, so she can’t get a Medicare Supplement until then as well.
If you are in Arizona you can go to my website for contact info. Medicarechoicesofarizona.com
When a Medicare Advantage plan pulls out of an area, the most important benefit for the enrollees is that they can get “guaranteed issue” status to go back to Original Medicare and a PDP. If you have any clients with poor health, this is especially important because they normally are unable to get a decently priced Med Supp if they have any medical issues. The cancellation letter they get from their MAPD plan states that they have guaranteed issue for a Med Supp and this can be a really good deal for many seniors. They would then get a PDP.
Craig:
This would be great news for agents during October to get a head start as many plans are pulling out of PFFS, however, I have a question regarding the SEP:
Even if you have the paperwork from the carrier or do telephonic enrollment, how is it that this SEP allows for a 1/1/2010 effective date when the application is signed in October?
Typically, even if someone qualifies for an SEP, they are still enrolled for the first of the following month?
Your SEP reference link clearly says they can enroll on 11/1, 12/1, or 1/1 (or even 2/1), but it seems that would mean that if you get the application signed in October that it is for an 11/1 date, not 1/1?
Is that reference directly from CMS, or a summary?
Again, it would be great news, especially if we can do the 1/1′s in October, but I just want to make sure we’re interpretting correctly.
Thanks!
John:
Sorry I didn’t reply sooner. This comes directly from Chapter 2 of the Managed Care Manual. Here is the link: http://www.cms.hhs.gov/MedicareMangCareEligEnrol/Downloads/DraftMAEnrollmentGuidanceUpdate2010.pdf
You can also go here in case this link changes: http://www.cms.hhs.gov/MedicareMangCareEligEnrol/
See section 30.4.3 (page 38) for the direct CMS language on this situation.
Great question, thanks!
Craig
Excellent! Great news.
Thanks for the link. It is very clear that they can choose their effective date. (just not earlier than the date the application is received).
I work for a health plan and I can’t emphasize enough that you clearly note that the app. is an SEP and not an AEP. You may even want to write SEP somewhere on the front.
Yes, we should catch the fact that the little SEP box is checked but I can tell you based on experience that it is very easy to over look.
Craig:
Another thing…. How would you suggest we write these plans on October 1 for 1/1/10 effective dates if we don’t have the paperwork for 2010 enrollments or we don’t know exactly what the details of the 2010 plans are this early?
I can’t remember when the following years supplies are ready or the details of the upcoming years plan become available but I am not sure it is as early as October 1.
Mike:
If there is an electronic or telephonic enrollment option, I would go with that. Generally, 2010 sales materials are not available on October 1st.
Craig:
Can these people be written for 11/01/09 effective dates?
Mike:
Yes, you can write them for a 11/1 or 12/1 effective, as well as 1/1/10 (of course, you can’t “backdate”, I’m sure you know this, but just wanted to clarify).
Only issue with a 11/1 or 12/1 would revolve around resetting a MOOP.
Of course, if you wrote a 11/1, it would be changed over to the 2010 benefits on 1/1/10, automatically.