Question: Mr. Trejo has Medicare Parts A and B with a Part D plan. Last year, he received a notice that his plan sponsor identified him as a "potential at-risk" beneficiary. This month, he started receiving assistance from Medicaid. He wants to find a different Part D plan that's more suitable for his current prescription drug needs. He believes he's entitled to a SEP since he is now a dual-eligible. Is he able to change to a different Part D plan during a SEP for dual-eligible individuals? Need Assignment Help?
Question Answer
a. No. Once he is identified by the plan sponsor as a "potential at-risk" beneficiary, he cannot use the dual eligible SEP to change plans while this designation is in place.
b. Yes. "Potential at-risk" designations are just a warning. Only "at-risk" beneficiaries are prohibited from using this SEP while the designation is in place.
c. Yes. The "potential at-risk" designation only impacts the services he may receive from the Part D plan he enrolls, but it doesn't affect his ability to change plans during this SEP.
d. No. Individuals identified by the plan sponsor as "potential at-risk" must wait 2 years to switch plans, after which time the designation is lifted.