MA OEP question

sbg_ben

Guru
264
If a client has a Medicare advantage plan as a retiree through their employer, can they use the MA OEP to change plans to one that they purchase on their own through a carrier?

The MA plan they have through their employer has exited a major hospital group that all their doctors are a part of. So I'm helping them explore their options. I can't find anything that says anything definitive on whether or not you could use the open enrollment period in this situation.

Does anyone have a source of information on this that they can point me to?

Thanks
 
If a client has a Medicare advantage plan as a retiree through their employer, can they use the MA OEP to change plans to one that they purchase on their own through a carrier?

The MA plan they have through their employer has exited a major hospital group that all their doctors are a part of. So I'm helping them explore their options. I can't find anything that says anything definitive on whether or not you could use the open enrollment period in this situation.

Does anyone have a source of information on this that they can point me to?

Thanks
normally i would use loss of eghp sep in this situation .i don't think i have ever used oep so can't say 100% it would work.

it is very common that group ma plans are ppo plans with same cost share in network and out of network to accommodated retirees who may reside anywhere in the US but of course this doesn't mean the provider has to accept it oon but it is very possible they will since the providers are still going to paid the full boat.it is easy to find info on most large group ma plan by just googling for example att retiree group medicare advantage just to confirm you are not doing them dirty.

 
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Probably doesn't need to be said, but likely would not be able to opt back in on an employer offered MAPD offered as a retiree benefit, and should be confirmed so an informed decision is made. Not to avoid dropping just understanding the options.
Yes I completely agree, I told them that they need to check with their employer on that before we do anything. I'm glad you are bringing that up though because it might save someone else from making a mistake in the future!
 
normally i would use loss of eghp sep in this situation .i don't think i have ever used oep so can't say 100% it would work.

it is very common that group ma plans are ppo plans with same cost share in network and out of network to accommodated retirees who may reside anywhere in the US but of course this doesn't mean the provider has to accept it oon but it is very possible they will since the providers are still going to paid the full boat.it is easy to find info on most large group ma plan by just googling for example att retiree group medicare advantage just to confirm you are not doing them dirty.


Upon further questioning, she did say that her plan has the same in network and out of network benefits. The issue is that this hospital system and insurance carrier must be having some kind of big issue with each other. So some people at the billing department in the hospital are saying that even if Humana sends them a bill, they aren't going to pay it. This seems unlikely but there is really nothing I can do to confirm or deny it on my end.

My advice was to look into switching to the other hospital system in the area which is incredibly well known and has great results. She may end up with a much better doctor and surgeon and this may end up being a good thing at the end of the day. I did make it clear that this was my insurance advice and not medical advice though!
 
Upon further questioning, she did say that her plan has the same in network and out of network benefits. The issue is that this hospital system and insurance carrier must be having some kind of big issue with each other. So some people at the billing department in the hospital are saying that even if Humana sends them a bill, they aren't going to pay it. This seems unlikely but there is really nothing I can do to confirm or deny it on my end.
It's very likely. A lot of doctors that don't want to bill a company, refuse to bill them OON as well.
We have a humana part B giveback PPO in FL that charges the same IN or ONN. I let people know that yes, you can see any doctor that accepts Medicare. But, if they aren't willing to bill the company, you'll have to file the claim.
 
Well, there is that . . . .

Which is why I tell my T65's if they can afford the monthly premium, take a med Supp. The MAPD can cost you just as much, if not more, if you have health issues, and you can lose your doctor, or have access to less doctors.

But, 50% still choose a MAPD. I'm not leaving $200k a year on the table. I take my notes and if they complain later, I have their statements to back it up.
 
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