Exception rules for MA coverage...???

[Mike Siegal]

Hey buds,

I know two of the rules for switching plans outside of a OEP

• -Moving to new area
• -a chronic condition has developed

Can anyone list any more exceptions for changing an MA plan?

Thanks very much

 

[DS4]

Special circumstances (Special Enrollment Periods) | Medicare

 

[somarco]

If you believe you made the wrong plan choice because of inaccurate or misleading information, including using Plan Finder,

I wonder how many folks get out of their plan for these reasons.

Asking for a friend . . .

 

[Mike Siegal]

If you believe you made the wrong plan choice because of inaccurate or misleading information, including using Plan Finder,

I wonder how many folks get out of their plan for these reasons.

Asking for a friend . . .

Ahhahaha !

Yep...'they get a letter from their NEW DR.'...!

 

[StephanieCJ]

If you believe you made the wrong plan choice because of inaccurate or misleading information, including using Plan Finder,

I wonder how many folks get out of their plan for these reasons.

Asking for a friend . . .

I helped a client change their PDP last year because of inaccurate plan finder info. Had the printout from Medicare.gov with the wrong info.

 

[somarco]

I helped a client change their PDP last year because of inaccurate plan finder info. Had the printout from Medicare.gov with the wrong info.

Given the failure rates of the Mcare PF I would expect a high percentage of folks could qualify for an SEP.

My comment was directed more towards the "inaccurate or misleading" VERBAL information including the Broadway Joe ads. Of course there are a number of agents who can write hundreds of apps and yet they lack even a basic understanding about how those plans actually work.

How many appeals are approved because of oral representations that conflict with what the policy language and brochures actually say?

 

[Limozine]

Hey buds,

I know two of the rules for switching plans outside of a OEP

• -Moving to new area
• -a chronic condition has developed

Can anyone list any more exceptions for changing an MA plan?

Thanks very much

With a little creativity and thinking outside the box, there are quite a few ways to get someone on a plan outside of AEP or OEP. The list of chronic conditions that qualify for a CSNP SEP is so broad ("coronary artery disease" for example; clients with high cholesterol) that I'd say half or more seniors could qualify. Plus, the CMS rule for "found ineligible for CSNP" is so vague, that if your client applies for a CSNP and is rejected, that in and of itself could qualify them for an SEP. In that case, EVERYONE could qualify for an SEP: those who are eligible for a CSNP and those who apply and are found ineligible.

 

[StephanieCJ]

With a little creativity and thinking outside the box, there are quite a few ways to get someone on a plan outside of AEP or OEP. The list of chronic conditions that qualify for a CSNP SEP is so broad ("coronary artery disease" for example; clients with high cholesterol) that I'd say half or more seniors could qualify. Plus, the CMS rule for "found ineligible for CSNP" is so vague, that if your client applies for a CSNP and is rejected, that in and of itself could qualify them for an SEP. In that case, EVERYONE could qualify for an SEP: those who are eligible for a CSNP and those who apply and are found ineligible.

You would have to be in an area where CSNP is available (not the case for the vast majority of my state or the rural parts of neighboring states to me).

 

[StephanieCJ]

Given the failure rates of the Mcare PF I would expect a high percentage of folks could qualify for an SEP.

My comment was directed more towards the "inaccurate or misleading" VERBAL information including the Broadway Joe ads. Of course there are a number of agents who can write hundreds of apps and yet they lack even a basic understanding about how those plans actually work.

How many appeals are approved because of oral representations that conflict with what the policy language and brochures actually say?

I've helped with some of those as well, but only when there was a clear issue (client told their PCP was in network when they weren't, guy called a client saying he was renewing her Medicare and worked with me when he was changing a plan and doesn't work with me, etc.). As an agent, it is important to note what you go over during a presentation if you are doing them correctly. (I've yet to have that happen, but an agent locally who I would trust my parents with had to fight a complaint made against him that was false).

 

[vic120]

With a little creativity and thinking outside the box, there are quite a few ways to get someone on a plan outside of AEP or OEP. The list of chronic conditions that qualify for a CSNP SEP is so broad ("coronary artery disease" for example; clients with high cholesterol) that I'd say half or more seniors could qualify. Plus, the CMS rule for "found ineligible for CSNP" is so vague, that if your client applies for a CSNP and is rejected, that in and of itself could qualify them for an SEP. In that case, EVERYONE could qualify for an SEP: those who are eligible for a CSNP and those who apply and are found ineligible.

You not only have to be in the area where there is one available

as one mentioned not all over and there are way more diabetes the Heart

2nd they can enroll you based on your answers and then drop you on confirmation

I would hate to be the agent that gets a client dropped because he tried to pass off high cholesterol as Coronary artery disease

Yes you may get SEP, However,The client may not like what they went through and report you

Also, the Ins company may ding you for trying to pass off nonsense especially if there is a pattern

And 3rd many times the CSNP is not better than the reg MAPD plans