Med Supp, PDP, Original medicare to MAPD?

[BeeSelective]

Mrs. Ridgeway enrolled in Original Medicare and Medigap coverage following her retirements several years ago. Four months ago, Mrs. Ridgeway dropped her Medigap policy to enroll in a Medicare Advantage (MA) plan for the first time. Unfortunately, Mrs. Ridgeway has found that many of her providers are not in the MA plan's network. She has come to you for advice? What should you tell her?

Choose one answer.


a. She qualifies for a special enrollment period (SEP) that will allow her to make a one-time election to return to Original Medicare and she also has a guaranteed eligibility period to rejoin her Medigap plan.


b. She must wait until the next MA Open Enrollment Period (OEP) during which she can elect to return to Original Medicare.


c. She must wait until the next Annual Election Period (AEP) during which she may select another MA plan.


d. She qualifies for a special enrollment period (SEP) that will allow her to make a one-time election to return to Original Medicare, but she may or may not qualify to rejoin her Medigap plan based on medical underwriting.

My question:

If she goes back to Med Supp and Original Medicare, what is her PDP option in August?

 

[TwoCents]

F. Return her to med supp and use this election to enroll into a PDP that will term MA:

SEP for Individuals Who Dropped a Medigap Policy When They Enrolled For the First Time in an MA Plan, and Who Are Still in a "Trial Period" – Individuals who dropped a Medigap policy when they enrolled for the first time in an MA plan are provided a guaranteed right to purchase another Medigap policy if they disenroll from the MA plan while they are still in a "trial period." In most cases, a trial period lasts for 12 months after a person enrolls in an MA plan for the first time. If the individual is using this SEP to disenroll from an MA-PD plan, there is a Part D SEP to permit a one-time enrollment into a PDP. This SEP opportunity may only be used in relation to the MA SEP described here and begins the month they disenroll from the MA-PD plan and continues for two additional months.

 

[vic120]

F. Return her to med supp and use this election to enroll into a PDP that will term MA:

SEP for Individuals Who Dropped a Medigap Policy When They Enrolled For the First Time in an MA Plan, and Who Are Still in a "Trial Period" –,Individuals who dropped a Medigap policy when they enrolled for the first time in an MA plan are provided a guaranteed right to purchase another Medigap policy if they disenroll from the MA plan while they are still in a "trial period." In most cases a trial period lasts for 12 months after a person enrolls in an MA plan for the first time. If the individual is using this SEP to disenroll from an MA-PD plan, there is a Part D SEP to permit a one-time enrollment into a PDP. This SEP opportunity may only be used in relation to the MA SEP described here and begins the month they disenroll from the MA-PD plan and continues for two additional months.

Its Option A

You are mostly correct except "Individuals who dropped a Medigap policy when they enrolled for the first time in an MA plan are provided a guaranteed right to purchase another Medigap policy if they disenroll from the MA plan while they are still in a "trial period." In most cases'

Its only GI if the go-to original Company or AARP(as they have their own rules) another company would be underwritten

 

[TwoCents]

Its Option A

You are mostly correct except "Individuals who dropped a Medigap policy when they enrolled for the first time in an MA plan are provided a guaranteed right to purchase another Medigap policy if they disenroll from the MA plan while they are still in a "trial period." In most cases'

Its only GI if the go-to original Company or AARP(as they have their own rules) another company would be underwritten

Yeah, I was going to go with A, but based on Bee's last question about PDP coverage for August, it made me think that Bee wasn't aware that there's an election that works alongside leaving the MA that will allow the PDP enrollment.

 

[BeeSelective]

F. Return her to med supp and use this election to enroll into a PDP that will term MA:

SEP for Individuals Who Dropped a Medigap Policy When They Enrolled For the First Time in an MA Plan, and Who Are Still in a "Trial Period" – Individuals who dropped a Medigap policy when they enrolled for the first time in an MA plan are provided a guaranteed right to purchase another Medigap policy if they disenroll from the MA plan while they are still in a "trial period." In most cases, a trial period lasts for 12 months after a person enrolls in an MA plan for the first time. If the individual is using this SEP to disenroll from an MA-PD plan, there is a Part D SEP to permit a one-time enrollment into a PDP. This SEP opportunity may only be used in relation to the MA SEP described here and begins the month they disenroll from the MA-PD plan and continues for two additional months.

Where do you find this? Humana doesn't know this. I had a lady with a med supp @ $350 / month and a Human PDP. I enrolled her in Human MAPD effective 01/01/2020. In April she called saying her Doctor was taking her plan, but he was not in the PPO and her costs were higher than expected.

I called Humana asking how to change it. I was told, "she has no PDP option". She can get a Supplement, but she can't get a PDP til AEP.

That's what Humana said.

Thanks for your reply.

 

[BeeSelective]

Its Option A

You are mostly correct except "Individuals who dropped a Medigap policy when they enrolled for the first time in an MA plan are provided a guaranteed right to purchase another Medigap policy if they disenroll from the MA plan while they are still in a "trial period." In most cases'

Its only GI if the go-to original Company or AARP(as they have their own rules) another company would be underwritten

The problem is Humana told me she had no PDP option till AEP. I can't believe that!

Thanks for your reply.

 

[vic120]

The problem is Humana told me she had no PDP option till AEP. I can't believe that!

Thanks for your reply.

Humana Was wrong



It is an SEP as stated before

 

[BeeSelective]

Yeah, I was going to go with A, but based on Bee's last question about PDP coverage for August, it made me think that Bee wasn't aware that there's an election that works alongside leaving the MA that will allow the PDP enrollment.

Human told me she had no option. She had Humana PDP, changed to Humana MAPD PPO, can get the GI Supp, but Humana says she can't go back to her PDP. I would really like to change this for her since the MAPD isnt working with her PCP. (In November, the Dr office told her they would accept it. They do, but not in Network.)

thanks for your reply.

 

[vic120]

Human told me she had no option. She had Humana PDP, changed to Humana MAPD PPO, can get the GI Supp, but Humana says she can't go back to her PDP. I would really like to change this for her since the MAPD isnt working with her PCP. (In November, the Dr office told her they would accept it. They do, but not in Network.)

thanks for your reply.

I just told you Humana Lied it is an sep to get PDP

 

[BeeSelective]

Humana Was wrong



It is an SEP as stated before

I couldn't imagine no PDP option. Could you please tell me where you find that?