Comments on: Special Election Period for Medicare Advantage Beneficiaries who are Being Disenrolled from their Medicare Advantage Plan for 2010 begins on October 1st, 2009

By: Rob

Rob — Thu, 01 Oct 2009 20:04:28 +0000

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:

By: Craig

Craig — Thu, 01 Oct 2009 20:00:30 +0000

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

By: Margaret

Margaret — Wed, 30 Sep 2009 22:14:21 +0000

Could someone tell the names of all of the companies that are pulling out of PFFS this year?

By: Marilyn

Marilyn — Wed, 30 Sep 2009 19:41:00 +0000

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

By: Rob

Rob — Tue, 29 Sep 2009 17:27:12 +0000

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…

By: Denise

Denise — Fri, 11 Sep 2009 14:49:53 +0000

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

By: yvonne barnett

yvonne barnett — Fri, 11 Sep 2009 09:08:20 +0000

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?

By: John

John — Mon, 17 Aug 2009 23:46:27 +0000

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).

By: azagent

azagent — Fri, 14 Aug 2009 04:45:42 +0000

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.

By: Craig

Craig — Wed, 12 Aug 2009 15:17:55 +0000

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