Smoothing on part D is going to be a nightmare

DonP

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I was just watching very detailed podcast on it . You sign up for it when you take a plan out. The carrier bills you monthly (lol,lol). If you don’t pay it the carrier can’t disenrolled you . But they can send to collections after 90 days . Also if you leave the plan and come back to the company at a later date they can start billing you for the past due . How does this work if you sign up for a plan Jan 1st and flip plans to new carrier during oep? Does the carrier forward the billing info to the new carrier ? Wow this is going to be a nightmare. I’m pretty sure most agents will wash there hands of helping with Part D if not being paid .
 
not sure what you are getting at this is not new
I have seen that on MA plans when MA plans used to have premiums more often

I had several with UHC between 2011 and 2014 who got hit with owed balances from previous plan a year or 2 before
 
not sure what you are getting at this is not new
I have seen that on MA plans when MA plans used to have premiums more often

I had several with UHC between 2011 and 2014 who got hit with owed balances from previous plan a year or 2 before
I’ve seen on plans too but it was pretty rare . I’m more concerned how you move a plan during aep , sep etc on how the billing transfers to the new carrier ? Also another huge issue if members stop paying their $167 a month ($2000 moop / 12 months . The carrier can terminate the monthly payment . When they go refill their drugs they get popped with the $590 deductible immediately. Then most plans will have coins so the client hits his $2000 moop fast . More calls for agents
 
I am not sure how this will work out. I have seen different interpretations, and to me it still isn't clear how it will all unravel.
Last I saw on the Medicare site was that the individual medication had to be 600 or more at the point of sale for this to be available.
I don't think it is as simple as "your meds will cost more than $2000 this year so you will just be billed $167 a month starting in January".
Agents need to be very wary of this because I for one do not want to become a debt collector for the carriers.
 
not sure what you are getting at this is not new
I have seen that on MA plans when MA plans used to have premiums more often

I had several with UHC between 2011 and 2014 who got hit with owed balances from previous plan a year or 2 before

Yes UHC will not approve a new enrollment if there is a past balance due balance for part D premiums but i wonder if they will be allowed to due this if past due is from financing copayments from smoothing.

i was on a UHC webinar last week and one thing they stressed about this smoothing deleo was for agents not to get under the hood and try to explain this to members.UHC or whichever carrier will identify and reach out to there members who will qualify for program.
 
Scenario #1: Client Grumpy Joe runs out of his meds. Calls doctor who prescribes high end drug again and sends it into Wally- World.

Grumpy Joe goes to WW to pickup his script which cost $650.00 Grumpy Joe hasn’t got $650.00 so the beleaguered pharmacist tells him that he can sign up for the Whiz-Bang pay me later plan BUT that he will have to call the EVIL insurance company first and wait for them to set him up first! (Side note: The customer service phone is manned overseas where you can hear the rooster in the background.)

So Grumpy Joe, out of medicine, has to go home and wait to be set-up in the EVIL system.

A few days later “Ol Grumpy” is approved and goes for his meds. (BTW the pharmacy hasn’t been paid for the drugs yet.)

A month later GJ gets his bill for “The Leveling” but you know it’s been a bad month for “Ol Joe. His car broke down, he’s behind on his light bill and those Lotto tickets just didn’t pan out. So GJ throws the bill on the large stack of other unpaid bills and grabs a Bud Light.

So EVL insurance can’t term him for not paying, the pharmacy is still waiting to be paid and now GJ NEEDS a refill on his meds.
Another great government bureaucrat solution for Grumpy Joe and all of us. Government says: “There we fixed it.”


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