I had a women who enrolled in a MAPD in August for the 1st time(turning age 65). Forgot to pay Part B. Was canceled by the MAPD in December. She just paid back the the Part B premiums and is now current. Now the MAPD is saying they cant reinstate her because doesnt have a SEP. Anyone ever run into this problem and how can she get the MAPD back?
Terminated from MAPD for Part B non payment, can you get MAPD reinstated?
- Thread starter Mink
- Start date
I think your best bet is to find an SEP. Check if:
- Is there a 5-Star Plan in the area?
- Is she eligible for LIS?
- Is she on an SPAP in her state?
- Is her state within a FEMA disaster zone?
- Does she have other creditable coverage through the VA or a spouse's employer?
- Is there a 5-Star Plan in the area?
- Is she eligible for LIS?
- Is she on an SPAP in her state?
- Is her state within a FEMA disaster zone?
- Does she have other creditable coverage through the VA or a spouse's employer?
StephanieCJ
Guru
- 678
She is SOL without an SEP. The only time I've seen the MAPD re-instated is when a client walked a check into the SS office and got a receipt and then subsequently had her Part B canceled for non-payment because they put the money on her account but didn't apply it to her part B premium.
This is a common reinstatement scenario. What happens is that the MA is notified by CMS that the person has been termed due to loss of Part B. Then if Part B is regained without lapse, then the MA can also be reinstated w/o lapse.
From CMS guidance.
Reinstatements for erroneous death indicator or loss of Part A or Part B entitlement:
Individuals can dispute the disenrollment due to death indicator or loss of Part A or Part B entitlement. In such cases, the MA organization is expected to acknowledge the individual's request for reinstatement and direct him or her to continue to use the MA plan services while the issue is resolved with the Social Security Administration (SSA). Organizations may request that such individuals provide evidence of MA eligibility by a particular date; however, should the individual provide evidence after that date, the error must still be corrected by the MA organization.
To request consideration for reinstatement following disenrollment due to erroneous death indicator, erroneous loss of Medicare Part A or Part B, the MA organization must submit to CMS (or its designee) a copy of the letter to the member informing him or her to continue to use MA plan services until the issue is resolved. The organization must indicate the date the letter was sent. Refer to model letters in Exhibits 15and 16. Within ten (10) calendar days of receipt of DTRR confirmation of the individual's reinstatement, the organization must send the member notification of the reinstatement (Exhibit 25a).
CMS will attempt to automatically reinstate individuals that were auto-disenrolled by a report of date of death if there is a subsequent date of death correction that impacts the plan enrollment.
From CMS guidance.
Reinstatements for erroneous death indicator or loss of Part A or Part B entitlement:
Individuals can dispute the disenrollment due to death indicator or loss of Part A or Part B entitlement. In such cases, the MA organization is expected to acknowledge the individual's request for reinstatement and direct him or her to continue to use the MA plan services while the issue is resolved with the Social Security Administration (SSA). Organizations may request that such individuals provide evidence of MA eligibility by a particular date; however, should the individual provide evidence after that date, the error must still be corrected by the MA organization.
To request consideration for reinstatement following disenrollment due to erroneous death indicator, erroneous loss of Medicare Part A or Part B, the MA organization must submit to CMS (or its designee) a copy of the letter to the member informing him or her to continue to use MA plan services until the issue is resolved. The organization must indicate the date the letter was sent. Refer to model letters in Exhibits 15and 16. Within ten (10) calendar days of receipt of DTRR confirmation of the individual's reinstatement, the organization must send the member notification of the reinstatement (Exhibit 25a).
CMS will attempt to automatically reinstate individuals that were auto-disenrolled by a report of date of death if there is a subsequent date of death correction that impacts the plan enrollment.
