MAPD Enrollments outside of AEP

[Todd N]

Good Day Agents!!

I'm an independent agent, mainly sell Medigap policies but I do have quite a few MAPD members as well. My question is:

How are so many members enrolling into MAPD plans, NON-SNP plans, during the year. I've lost three members to Humana's telesales just the past two weeks. All of which signed up for an HMO, non SNP, for October 1. How is this even legal? How are they allowed to call and offer their products when those three don't even have Humana policies. How does CMS allow changes like this during the year without an election period? My guess from past years was the Humana reps used LIS election periods to get CMS to bite. But none of these people qualify. Ive discussed the limits and such, they won't qualify. Are they using that as a reason, then allowing MAPD enrollments to be denied, but continuing with the enrollment anyways?

Any ideas? I'm sick of it happening but I'm not sure there's a thing an independent agent like me can do when companies have unlimited resources to call and ad sell my clients daily.

Thank you guys.

 

[Special Agent]

Good Day Agents!!

I'm an independent agent, mainly sell Medigap policies but I do have quite a few MAPD members as well. My question is:

How are so many members enrolling into MAPD plans, NON-SNP plans, during the year. I've lost three members to Humana's telesales just the past two weeks. All of which signed up for an HMO, non SNP, for October 1. How is this even legal? How are they allowed to call and offer their products when those three don't even have Humana policies. How does CMS allow changes like this during the year without an election period? My guess from past years was the Humana reps used LIS election periods to get CMS to bite. But none of these people qualify. Ive discussed the limits and such, they won't qualify. Are they using that as a reason, then allowing MAPD enrollments to be denied, but continuing with the enrollment anyways?

Any ideas? I'm sick of it happening but I'm not sure there's a thing an independent agent like me can do when companies have unlimited resources to call and ad sell my clients daily.

Thank you guys.

They are using the SEP-Commish election code.lol They are most likely using the SEP FEMA which can be used over and over and i don't think it even matters if the consumer lives in an affected area.I also don't think they verify most other SEPs either but it is fraud so they are definitely taking a risk.

 

[Tscholar]

I've had this happen. They are using SEPs that the plan members don't qualify for and unfortunately, CMS is not checking. could be a disaster SEP or I had one that said she lost some type of coverage, but it wasn't employer coverage. they are all kinds of SEPs out there!

 

[DS4]

How are so many members enrolling into MAPD plans, NON-SNP plans, during the year. I've lost three members to Humana's telesales just the past two weeks. All of which signed up for an HMO, non SNP, for October 1. How is this even legal?

There are probably 14,000 SEP's in your geographical area. Pick one you like and run with it.

 

[Todd N]

Using fraudulent SEPs harms individual agents the most in this environment. You are on an island by yourself. You can't prevent large call centers from calling daily or rushing your clients with mailers. I warn clients about these types of reps, heck I even sell most MAs in my area, but I guess human nature is always to wonder if the grass is greener.

 

[Fisher]

They are using the SEP-Commish election code.lol

Made me chuckle! Sucks, but accurate.

 

[hockeyday]

I've had this happen. They are using SEPs that the plan members don't qualify for and unfortunately, CMS is not checking. could be a disaster SEP or I had one that said she lost some type of coverage, but it wasn't employer coverage. they are all kinds of SEPs out there!

It's the carrier responsible to check the sep, they send it to cms after they certify the enrollment sep, cms then process the enrollment,

 

[Todd N]

Was told by a trusted source that the SEP used was "low performing MAPD plan with lower than 3 stars" per my source. Funny because this member doesn't even have a MAPD plan, she has original medicare. What a joke CMS has become. It's open season year round. By the way, I heard it was a company called OneDigital who did the enrollment. So OneDigital has frauds working for them. Seniors beware!

 

[bluediamond]

Florida will probably have a SEP most of next year due to hurricane Helene.

 

[Todd N]

Florida will probably have a SEP most of next year due to hurricane Helene.

You are right. If the wind blows hard, a weather related SEP will be issued. The problem is the clowns use it to submit fraudulent SEP to try and dodge CMS and make a quick dollar. It's nuts.