Opinions on what is expected with the final rule for Medicare

[DonP]

No!!!

It's 3 different SEPs --

1. Brand New -- The integrated DSNP monthly SEP.

2. Updated -- The quarterly SEP becomes monthly and changes to allow only PDP enrollment.

3. Status Quo -- Gain/Loss/Change SEP stays the same.

We’ll see . What I read said lis / partial can’t move quarterly anymore . It’s irrelevant anyway because with all the seps anyone can move anytime anyway

 

[goillini52]

Beginning September 1, 2024, short-term products are restricted to a term of no more than 3 months with an option one month renewal or extension, for a maximum duration of no more than 4 months.

Ok, so I enroll Joe Blow into a Short Term plan on 01/01/24. He has answered NO to all health questions and thinks that he's healthy. Then he goes to the doctor for a pain a month later and finds out that he has cancer, needs heart surgery etc. Surgery scheduled for 04/01.

His ST policy has ended and he can't qualify for a new ST and he's passed the ACA open enrollment. So he is Sh*t out of luck until the next ACA open enrollment.

Is he just supposed to suck it up and die?

According to Integrity:

Update on Short-Term Medical Health Plans​ ​

On March 28, 2024, the Department of Health and Human Services (HHS), Labor, and the Treasure Departments released final rules for short-term medical (STM) insurance plans proposed by the Biden administration in 2023. The new proposal aims to shorten STM durations to a maximum of three months with a one-month extension and not allow policies to be sold again with the same insurance carrier for a period of 12 months from the original effective date of coverage. Here are the highlights: As of September 1, insurance carriers are limited to offering 3 months of short-term medical coverage with a 1-month extension to any consumer within a 12-month period. Agents or brokers and marketing companies are not precluded from offering clients additional coverage from other insurance companies. New disclosures of marketing material, applications, and certificates must clearly outline the differences between short-term medical and Affordable Care Act (ACA) coverage to help consumers make the most informed purchasing decision. What Does This Mean for Consumers? If a consumer, after 4 months of coverage, wants to purchase another short-term medical policy, they will need to find a different insurance carrier and go through the application process again. This process could continue for as long as the consumer wants to purchase more short-term medical coverage and can pass underwriting each time, subject to state availability. We will keep you informed as we move forward, but it's important to remember that until September 1st, it is business as usual for you. Focus on serving your customers with the products we offer today. We offer many solutions for your clients who don't quite fit the ACA mold yet would be uninsured if they didn't have immediate coverage options.​

 

[wehotex]

We’ll see . What I read said lis / partial can’t move quarterly anymore . It’s irrelevant anyway because with all the seps anyone can move anytime anyway

WHICH other SEPs are you talking about? Disaster? Removal of this quarterly LIS is a substantial one for me.

 

[DonP]

WHICH other SEPs are you talking about? Disaster? Removal of this quarterly LIS is a substantial one for me.

Well disaster is only legitimate one. Call centers use State pharmaceutical one. Thats risky as CO’s have warned against it as being fraudulent . I’m not risking my renewals for that

 

[vic120]

Well disaster is only legitimate one. Call centers use State pharmaceutical one. Thats risky as CO’s have warned against it as being fraudulent . I’m not risking my renewals for that

What what's wrong with lis SEP's?

Or am I missing something are you more talking about misusing the Lis sep

 

[DonP]

The items below aren’t in order . These are the new rules on dsnps /lis If a persons moving from an integrated dsnp they can switch to another integrated dsnp or a pdp on a monthly basis . If there not on an integrated dsnp it’s the rules of regular mapd . Cms says “ to cut down on agressive marketing year round “ . So this should cut down big on flipping after oep . I’m sure if call centers start using bogus aeps complaints t Medicare will sky rocket and carriers will crack down big

 

[DonP]

What what's wrong with lis SEP's?

Or am I missing something are you more talking about misusing the Lis sep

Were talking about seps in 2025

 

[vic120]

Were talking about seps in 2025

so lis will not get one change outside of other EP's after this year?

 

[DonP]

so lis will not get one change outside of other EP's after this year?

If you read the cms rules above it appears that way . It appears unless it’s integrated dsnp . I read somewhere that partial duals /lis same rules as non integrated duals

 

[Surancedawg]

Beginning September 1, 2024, short-term products are restricted to a term of no more than 3 months with an option one month renewal or extension, for a maximum duration of no more than 4 months.

Ok, so I enroll Joe Blow into a Short Term plan on 01/01/24. He has answered NO to all health questions and thinks that he's healthy. Then he goes to the doctor for a pain a month later and finds out that he has cancer, needs heart surgery etc. Surgery scheduled for 04/01.

His ST policy has ended and he can't qualify for a new ST and he's passed the ACA open enrollment. So he is Sh*t out of luck until the next ACA open enrollment.

Is he just supposed to suck it up and die?

Gawd, so the Feds are regulating STMs now? I haven't sold STMs in several years, but the limits on the length of coverage were always set by the states. Some states like Texas allowed them to be as long as 12 months, while other states limited them to 6 or 3 month periods.

Since STMs don't receive any kind of federal subsidies, what business does Fed.Gov have regulating them? The Biden Administration needs to stick to the important stuff, like making sure the font on Joe's teleprompter screen is big enough and the words are moving slowly so he can read them.