OEP - It’s Not for Everyone OEP – If Not for Everyone . . . Then Who is it for? What Changes Can Be Made? But there’s more . . . a beneficiary can also choose to go back to Original Medicare and elect a stand-alone prescription drug plan. Typically, this happens when the beneficiary is moving back to Original Medicare with a supplemental plan (Medigap) from a newly elected Medicare Advantage plan. If, and only if, it was the beneficiary’s first time enrolling in a Medicare Advantage plan, they can use their trial right to go back to the previous Medicare supplement plan that was in force for PY 2019 without evidence of insurability. What Can You, the Producer, Do? OEP is specifically allowed for by CMS to protect Medicare beneficiaries in Medicare Advantage plans in case they were confused, or subsequently discovered that their medications were not covered by the formulary, or that their doctors were not in the plan’s network. What You Can’t Do
Producers Can
Things to Consider It is important to remember that unless the Medicare supplement can be reinstated without evidence of insurability, your client may lose coverage. Proceed cautiously. If you submit the PDP and the Medicare supplement application at the same time and the client is denied on the supplement plan, your client may end up with having original Medicare and a drug plan – with no supplemental coverage. So, understand the situation. It may be more beneficial for the beneficiary to select a different MA/MAPD plan. Do what is right by the client. ![]() |
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OEP - It’s Not for Everyone
Posted by www.psmbrokerage.com Admin on Wed, Jan 22, 2020 @ 12:40 PM
Tags: Medicare Advantage, Medicare, Medicare Part D, OEP