ESRD Regs/Medicare

[asher]

Hello All,

I have a 64 yr old client on an ACA who had a kidney removed in Dec '2018.
I received a call yesterday that he just received Medicare A&B as of 10/1/2019.
He turns 65 because of age in Jan 2020.

I recommended the MAPD for 10/1-12/31 with same carrier as his ACA plan because he is underage
Then in Dec. I recommended we do a medicare supplement since he is aging-in in we have open enrollment.

I have been searching for the regs that allow me to do this.
Can't find anything on Medicare.gov.
maybe I'm phrasing/querying incorrectly?

can anyone help me find pronted rules of what I'm allowed to do??

thanks for any input.

 

[Hopes]

He's not allowed to enroll in MA plans with ESRD. Unless there's a SNP specifically for ESRD in his area.

 

[LewB]

I believe you will find what you are looking for on page 40 of the 2019 Choosing a Medigap Policy.

 

[Hopes]

This publication explains his options. https://www.medicare.gov/sites/default/files/2018-07/10128-s-medicare-coverage-esrd.pdf

Also, you said he had a kidney "removed". Did he have a transplant? The publication says he would be eligible with a successful "transplant".

 

[Todd King]

When he turns 65 the clock resets. He can get anything he wants, whether it be a med supp, medicare advantage, or even nothing. Treat him just like any other turning 65.

 

[TwoCents]

When he turns 65 the clock resets. He can get anything he wants, whether it be a med supp, medicare advantage, or even nothing. Treat him just like any other turning 65.

Not true.

However, since the MA will be with the same carrier as the ACA plan, this provision should allow the MA enrollment...
Conversions upon ICEP: Individuals who developed ESRD while a member of a health plan offered by an MA organization and who are converting to Medicare Parts A and B, can elect an MA plan in the same organization (within the same State) as their health plan during their ICEP. (“Conversion” is defined in §10 and the time frames for the ICEP are covered in §30.2.) The individuals must meet all other MA eligibility requirements and must fill out an enrollment request form or complete an alternate enrollment request mechanism to join the MA plan.

 

[TwoCents]

Also, just as an FYI, the ESRD restriction for MA enrollment goes away in 2021.

 

[Hopes]

However, since the MA will be with the same carrier as the ACA plan, this provision should allow the MA enrollment...
Conversions upon ICEP: Individuals who developed ESRD while a member of a health plan offered by an MA organization and who are converting to Medicare Parts A and B, can elect an MA plan in the same organization (within the same State) as their health plan during their ICEP. (“Conversion” is defined in §10 and the time frames for the ICEP are covered in §30.2.) The individuals must meet all other MA eligibility requirements and must fill out an enrollment request form or complete an alternate enrollment request mechanism to join the MA plan.

Thanks for pointing that out. I didn't catch the "same organization" part in the OP.

Also, good to know about 2021 change.

 

[asher]

Two Cents,
Thank you for your response.
You confirmed that what I am recommending is correct.

 

[Todd King]

Not true.

However, since the MA will be with the same carrier as the ACA plan, this provision should allow the MA enrollment...
Conversions upon ICEP: Individuals who developed ESRD while a member of a health plan offered by an MA organization and who are converting to Medicare Parts A and B, can elect an MA plan in the same organization (within the same State) as their health plan during their ICEP. (“Conversion” is defined in §10 and the time frames for the ICEP are covered in §30.2.) The individuals must meet all other MA eligibility requirements and must fill out an enrollment request form or complete an alternate enrollment request mechanism to join the MA plan.

It is no bearing that it is the same company. ACA and Medicare are totally different. Medicare sets the rules for the MA plans and not the ACA company. When a person turns 65, it resets everything. That's a fact!