New Part D Updates

[policy doctor]

If you're selling Ma and PDP plans, thought you might like to read the latest on CMS updates...esp LIS.

I hate to sound negative, but I've never done so much reading CONSTANTLY as when this MA business started.


Center for Medicare Advocacy

 

[MedSuppPro]

Your not negative, just stating a fact!

I'm on a 20 + minute hold with 1-800 Medicare. I have a 67 year old group member ending coverage July 1st (voluntary). She has had Part A and B since age 65. She wants MedSupp + Part D. Part D Broker Services at Coventry says she has to wait till Jan 2009. FMO doesn't know the answer. I thought I did. Maybe Medicare knows the answer!

 

[Bob_The_Insurance_Guy]

She does not have to wait. Just have her send to Medicare/CMS the Certificate of Creditable Coverage, which will include the end date, and that will suffice as proof. When coming off a group plan, they can sign up anytime throughout the year.

Education is the key, ladies and gentlemen. This is where cross-training from Med Supps to Medicare Advantage and Part D plans would really be beneficial. They key is to read the Medicare and You - 200_ book every year. I guarantee you, the information you seek is in there.

You can submit an Enrollment form for the Part D, and have her send the CCC when she receives it, which will be anytime between now and 30 days from separation.

 

[retread]

Your not negative, just stating a fact!

I'm on a 20 + minute hold with 1-800 Medicare. I have a 67 year old group member ending coverage July 1st (voluntary). She has had Part A and B since age 65. She wants MedSupp + Part D. Part D Broker Services at Coventry says she has to wait till Jan 2009. FMO doesn't know the answer. I thought I did. Maybe Medicare knows the answer!

You mean this lady has been paying her Part B for the last two years, even though covered by group? In this case group insurance would be primary, and her Part B was a waste of money! Perhaps there is more to it....

 

[sman]

She does not have to wait. Just have her send to Medicare/CMS the Certificate of Creditable Coverage, which will include the end date, and that will suffice as proof. When coming off a group plan, they can sign up anytime throughout the year.

Education is the key, ladies and gentlemen. This is where cross-training from Med Supps to Medicare Advantage and Part D plans would really be beneficial. They key is to read the Medicare and You - 200_ book every year. I guarantee you, the information you seek is in there.

You can submit an Enrollment form for the Part D, and have her send the CCC when she receives it, which will be anytime between now and 30 days from separation.

I have one for you Bob. A person turns 65 in 06/2006. She is on group coverage at the time and only goes on Medicare Part A. The coverage later turns into COBRA, but the employer pays the premium for the first 12 months. Now that the former employer is no longer paying the premium, she wants to go on Medicare Part B and get a Supp and Part D. Problem is, Medicare states since she has waited beyond the allowable time frame to apply for Part B, she will have to wait until the next enrollment period (January) and coverage under Part B won't start until next June. They state that COBRA does not qualify as "group" coverage and that she should have applied for Part B when the group coverage turned to COBRA. That's a new one on me.

 

[thereaper]

I have one for you Bob. A person turns 65 in 06/2006. She is on group coverage at the time and only goes on Medicare Part A. The coverage later turns into COBRA, but the employer pays the premium for the first 12 months. Now that the former employer is no longer paying the premium, she wants to go on Medicare Part B and get a Supp and Part D. Problem is, Medicare states since she has waited beyond the allowable time frame to apply for Part B, she will have to wait until the next enrollment period (January) and coverage under Part B won't start until next June. They state that COBRA does not qualify as "group" coverage and that she should have applied for Part B when the group coverage turned to COBRA. That's a new one on me.

Doesn't sound right to me either. But what month did she go on cobra and is cobra ending? If cobra is ending my understanding she is losing coverage thru no fault of her own and she can definitely get part B, Med Supp and Part D within 62 days of losing the cobra.

 

[Bob_The_Insurance_Guy]

The month after the employer stopped paying for group coverage, she should have elected for Part B coverage. COBRA is nothing more than you, the individual, buying out your employer's portion of cost to cover you for healthcare.

She DID wait too long, and therefore, must suffer the consequences. Too bad a well-informed insurance agent wasn't there to explain this to her.

COBRA is not group coverage, it is a government mandate that is available to the separated employee, and they have an option to accept or decline it.

Again, that information is covered in the Medicare and You 200_ book that is sent to all Medicare Beneficiaries every Oct/Nov. The information is also found on Medicare.gov - The Official U.S. Government Site for People with Medicare

 

[sman]

The month after the employer stopped paying for group coverage, she should have elected for Part B coverage.

Therein lies part of the problem. The employer continued to pay for the coverage (even though it was COBRA). And of course, they didn't realize they could have benefited from talking to an agent.

 

[retread]

.... Problem is, Medicare states since she has waited beyond the allowable time frame to apply for Part B, she will have to wait until the next enrollment period (January) and coverage under Part B won't start until next June...

Somebody either mis-spoke or didn't hear correctly, but the coverage doesn't begin until 7/1 for those enrolling during the OEP for Part B.

 

[MedSuppPro]

I'm on a 20 + minute hold with 1-800 Medicare. I have a 67 year old group member ending coverage July 1st (voluntary). She has had Part A and B since age 65. She wants MedSupp + Part D. Part D Broker Services at Coventry says she has to wait till Jan 2009. FMO doesn't know the answer. I thought I did. Maybe Medicare knows the answer!

Yep! Medicare told me: "Only Medicare can grant a special enrollment. Have the lady call 1-800Medicare and we will enroll her over the phone."
When I asked for a source, the Medicare rep hung-up.