03/01/2007   CMS provides clarification to Limited Open Enrollment Period

There is clarification from Centers for Medicare & Medicaid Services (CMS) on the Tax Relief and Health Care Act of 2006 which now allows beneficiaries enrolled in Original Medicare to enroll in Medicare Advantage (MA-only) plans in 2007 and 2008. CMS calls this a Limited Open Enrollment Period (L-OEP).

In January, we notified you in a Broker News article  explaining the details of the new law. CMS has now issued specific guidance on the rules which have changed from what was communicated last month.

Here’s how the L-OEP works:

• During L-OEP, Asuris can accept applications for our MedAdvantage-only plan (without Rx coverage) from Medicare beneficiaries who have Medicare Fee-for-Service –known to us as Original Medicare Parts A and B only or a Medigap plan.
• Medicare beneficiaries who have a standalone Part D prescription drug plan (PDP) will be automatically disenrolled from the PDP plan. Once they enroll in our MedAdvantage - only plan.
• Asuris cannot accept applications for MedAdvantage + Rx or MedAdvantage + Rx Enhanced as the L-OEP only provides for enrollment in Medicare Advantage-only plans without Part D coverage.

In the January CMS letter it was stated that after the January 1 – March 31, 2007 Open Enrollment Period (OEP), these Medicare beneficiaries could join our MedAdvantage-only plan without prescription coverage and keep their current PDP if they have one. This is incorrect.

The L-OEP is effective as of February 7, 2007 and will continue through 2007 and 2008. Medicare Fee-for-Service or Medigap beneficiaries will be able to use the L-OEP if there is not another election period available to them, such as the Open Enrollment Period (OEP) or Initial Enrollment Period when they turn 65 (ICEP). Applications that come into Asuris will be processed accordingly.

What this means to you:

• You can take applications from Medicare beneficiaries using the L-OEP for a MedAdvantage-only plan.
• You should ask clients if they have Part D coverage and explain they will automatically be disenrolled from it when they sign up for a Regence MedAdvantage plan during L-OEP.
• You should explain to your clients that they will not have Part D coverage with the MedAdvantage-only plan.

Click this link to view the actual CMS guidelines.

If you have questions about Medicare Advantage and Part D plans, please talk with your Asuris Sales contact.

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