CA medigap to MO medigap possible?

[UrAgenius]

I've got someone with pre-existing conditions who is on a California medigap plan that now lives in Missouri. California has a birthday rule to switch to a cheaper plan guarantee issue. Missouri has an anniversary date guarantee issue rules. Both rules overlap in this case.

I can't get a straightforward answer as to if my client can move from her CA F plan to a MO F plan on a guaranteed issue basis.

The only somewhat confident answer I got from someone is I can't do the MO anniversary rule because she has a CA plan right now, not a MO plan..

Longshot, but anybody know for sure?

 

[GoPokes]

I dont know the answer. But could you submit the application, and see what happens?

 

[sman]

I've got someone with pre-existing conditions who is on a California medigap plan that now lives in Missouri. California has a birthday rule to switch to a cheaper plan guarantee issue. Missouri has an anniversary date guarantee issue rules. Both rules overlap in this case.

I can't get a straightforward answer as to if my client can move from her CA F plan to a MO F plan on a guaranteed issue basis.

The only somewhat confident answer I got from someone is I can't do the MO anniversary rule because she has a CA plan right now, not a MO plan..

Longshot, but anybody know for sure?

Is there something that says it has to be a Med Supp written in MO in order to take advantage of the Anniversary Rule?

Have you spoken with an underwriter at a Med Supp carrier?

 

[somarco]

Medigap applications check with SSA to determine residency. If SSA says your prospect lives in MO then whatever GI rules exist in MO should apply here.

Whoever said the CA rules apply because that is the original issue state doesn't understand how this process works.

 

[UrAgenius]

Is there something that says it has to be a Med Supp written in MO in order to take advantage of the Anniversary Rule?

Have you spoken with an underwriter at a Med Supp carrier?

Not that I can find.

Haven't talked to an underwriter, just someone at my FMO that asked someone else and that's what I was told..

I may give it a go and forewarn the client it may not work.

 

[UrAgenius]

Medigap applications check with SSA to determine residency. If SSA says your prospect lives in MO then whatever GI rules exist in MO should apply here.

Whoever said the CA rules apply because that is the original issue state doesn't understand how this process works.

I called Ace(new med supp carrier in MO) underwriter and they said client would have to medically qualify to get a MO plan.

 

[sman]

I called Ace(new med supp carrier in MO) underwriter and they said client would have to medically qualify to get a MO plan.

I think the Ace underwriter is wrong.

This is from the Missouri Medigap Shopping Guide

"If you change to the same-lettered plan – for example, from Plan F at Insurer XYZ to Plan F at Insurer ABC, the new insurer cannot deny you coverage and cannot impose a waiting period based on pre-existing conditions.

To demonstrate that you qualify to change insurers, you are required to show only minimal proof. Simply produce a renewal notice (from your old insurer), invoice, the old policy or other confirmation of policy ownership to the agent or new company.

If you are told that you don't qualify, immediately call the Insurance Consumer Hotline at 800-726-7390."

I don't see anywhere that states it has to originally be purchased in Missouri. Notice it simply says to demonstrate you qualify, you are required to show minimal proof.

For what it's worth, I had a client move from Georgia to Missouri. He had been on a Blue Cross Blue Shield of Georgia for many years. Last year he changed to a Med Supp in Missouri (he has a brain tumor so he wouldn't pass underwriting). He used the Anniversary Rule. He wanted me to do it, but the commissions were minimal so I told him to just use the agent in Missouri. Point being, he switched as did his wife using the Anniversary Rule and neither got their original Med Supp in Missouri. I don't recall which company they used, but they definitely made the change.

 

[UrAgenius]

I think the Ace underwriter is wrong.

This is from the Missouri Medigap Shopping Guide

"If you change to the same-lettered plan – for example, from Plan F at Insurer XYZ to Plan F at Insurer ABC, the new insurer cannot deny you coverage and cannot impose a waiting period based on pre-existing conditions.

To demonstrate that you qualify to change insurers, you are required to show only minimal proof. Simply produce a renewal notice (from your old insurer), invoice, the old policy or other confirmation of policy ownership to the agent or new company.

If you are told that you don't qualify, immediately call the Insurance Consumer Hotline at 800-726-7390."

I don't see anywhere that states it has to originally be purchased in Missouri. Notice it simply says to demonstrate you qualify, you are required to show minimal proof.

For what it's worth, I had a client move from Georgia to Missouri. He had been on a Blue Cross Blue Shield of Georgia for many years. Last year he changed to a Med Supp in Missouri (he has a brain tumor so he wouldn't pass underwriting). He used the Anniversary Rule. He wanted me to do it, but the commissions were minimal so I told him to just use the agent in Missouri. Point being, he switched as did his wife using the Anniversary Rule and neither got their original Med Supp in Missouri. I don't recall which company they used, but they definitely made the change.

I called that consumer hotline and got the run around and referred to Missouri SHIP. Called them and they're going to have a "consulate" call me within 1-4 business days..

 

[somarco]

I called that consumer hotline

They don't have an AGENT hotline? Or is that where the bozo told you "no GI for you" since the policy was issued in CA?

ACE is a P&C carrier that entered the Medicare market 2 years ago. FWIW, P&C carriers don't have a good track record with Medicare products.

The one thing in your favor is the anniversary rule which should allow your client to bail if the ACE thing blows up . . .

 

[Duaine]

MO Anniversary Rule: Individuals have the annual right to switch Medicare supplement plans and avoiding medical underwriting. The new plan must be the same plan letter as the current plan, but it can be purchased from any insurance carrier. Policyholders must terminate their current plan within 30 days in either direction of their policy anniversary to be eligible.

8. Any individual who terminates Medicare supplement coverage within thirty (30) days of the annual policy anniversary.


(C) Guarantee Issue Time Periods.
1. In the case of an individual described in paragraph (B)1. of this section, the guaranteed issue period begins on the later of:
i) the date the individual receives a notice of termination or cessation of all supplemental health benefits (or, if a notice is not received, notice that a claim has been denied because of a termination or cessation); or

ii) the date that the applicable coverage terminates or ceases; and ends sixty-three (63) days thereafter.


2. In the case of an individual described in paragraph (B)2., (B)3., (B)5., or (B)6. of this section whose enrollment is terminated involuntarily, the guaranteed issue period begins on the date that the individual receives a notice of termination and ends sixty-three (63) days after the date the applicable coverage is terminated.

3. In the case of an individual described in subparagraph (B)4.A. of this section, the guarantee issue period begins on the earlier of:
i) the date that individual receives a notice of termination, a notice of the issuer's bankruptcy or insolvency, or other such similar notice if any, and

ii) the date that the applicable coverage is terminated, and ends on the date that is sixty-three (63) days after the date the coverage is terminated.


4. In the case of an individual described in paragraph (B)2., subparagraph (B)4.B. or (B)4.C., or paragraph (B)5. or (B)6. of this section who disenrolls voluntarily, the guaranteed issue period begins on the date that is sixty (60) days before the effective date of the disenrollment and ends on the date that is sixty-three (63) days after the effective date.

5. In the case of an individual described in paragraph (B)7. of this section, the guaranteed issue period begins on the date the individual receives notice pursuant to section 1882(v)(2)(B) of the Social Security Act from the Medicare supplement issuer during the sixty (60)-day period immediately preceding the initial Part D enrollment period and ends on the date that is sixty-three (63) days after the effective date of the individual's coverage under Medicare Part D.

6. In the case of an individual described in subsection (B) of this section but not described in the preceding provisions of this subsection, the guaranteed issue period begins on the effective date of disenrollment or the effective date of the loss of coverage under the group health plan and ends on the date that is sixty-three (63) days after the effective date.

(BTW Cigna Med Supp pays 15% commission for these. Most Mo Med Supp pay either 1% or a flat $25.00 one time fee.)

[EXTERNAL LINK] - Missouri Code of State Regulations, Chapter 3, Section 20 CSR 400-3.650 - Medicare Supplement Insurance Minimum Standards Act | Missouri Code of State Regulations | Justia