Guranteed Issue Question

[dandan]

I had a call from a gentleman today telling me his wife is in a nursing home, the nursing home is two counties away from the county they reside in.

They have a medicare advantage HMO and the doctor that treats the nursing home patients is not in the provider directory, actually the county the nursing home is in does not have any HMO's at all.

I think she should be eligible for guaranteed issue with a med supp since she moved out of the service area, but her home address is still the same as it has always been.

Has anyone else had this come up?

 

[thall]

Do not call cms, everything with them is generally, no concrete solution, call your FMO , get a certain resolution get their name,make sure they will stand behind their answer to your question. My suggestion change the addresse. Good Luck!

 

[MedSuppPro]

Is there a reason for the home address being the same? Is this person in an LTC or short-term care situation?

 

[GreenSky]

If she has moved out of the service area, she should be GI into a med supp.

Rick

 

[davidleekline]

Agree with GreenSky

 

[jdeasy]

I had a call from a gentleman today telling me his wife is in a nursing home, the nursing home is two counties away from the county they reside in.

They have a medicare advantage HMO and the doctor that treats the nursing home patients is not in the provider directory, actually the county the nursing home is in does not have any HMO's at all.

I think she should be eligible for guaranteed issue with a med supp since she moved out of the service area, but her home address is still the same as it has always been.

Has anyone else had this come up?

If a person moves out of the service area of the MA plan they have the right to buy a Medigap plan A, B, C, F, K or L that is sold in the state by any insurance company.

They only have this right if they switch to original medicare rather than joining another MA plan.

They can apply as early as 60 calendar days before the coverage ends, but no later than 63 calendar days after the coverage ends.

That's straight from the 2010 Choosing a Medigap Policy booklet. Page 24.

I suppose the only question is, did this person move out of the service area if they didn't change the address?

Does the MA plan consider it a move? Are they disenolling her because of a move? If they are, they will send a letter to that effect and that letter is the ticket for the GI to a med sup.

 

[AgentPipeline]

I had a call from a gentleman today telling me his wife is in a nursing home, the nursing home is two counties away from the county they reside in.

Is she permanently moved to the nursing home? I can bounce it off off a few companies and see what I can find out.

What state is she in?

 

[Frank Stastny]

This is definitely not a question for either CMS or an FMO. Why would anyone go anywhere except to the the one who has the final say whether or not it can be done?

Call the underwriting department with the company you want to write the policy with. Different companies may interpret that differently.

My best guess is that she is going to have to show a new permanent residence. Right now it sounds like her permanent address is still where she was living prior to going in the nursing home.

 

[Norwayguy]

This is definitely not a question for either CMS or an FMO. Why would anyone go anywhere except to the the one who has the final say whether or not it can be done?

Call the underwriting department with the company you want to write the policy with. Different companies may interpret that differently.

My best guess is that she is going to have to show a new permanent residence. Right now it sounds like her permanent address is still where she was living prior to going in the nursing home.

Frank I agree and disagree with you on this one...Wouldn't the place to go be her MA company because you will need them to generate the letter for the SEP...no SEP no conversion back to OM.

 

[Frank Stastny]

Frank I agree and disagree with you on this one...Wouldn't the place to go be her MA company because you will need them to generate the letter for the SEP...no SEP no conversion back to OM.

The "short" answer is no.

First of all you are assuming that they are going to give you accurate information regarding what the provisions for doing that are with the Med Supp company you want to move them to. They aren't going to know that but it may not keep them from giving you an "off the wall", incorrect answer.

It's kind of like calling the agent who sold them the policy and asking that agent if it is a good idea for their client to take a policy with you.

Each individual insurance company may have different rules and regs regarding how they handle that. Just because company A will do it that doesn't mean that company B will handle it exactly the same way.

If an agent's intent is to present accurate information concerning whether or not a company will process an application and issue a policy, then the underwriting department of that company is the only place to get the correct answer.

Every agent should have the phone number of every underwriting department of every company the are representing programmed in their phone. I don't ever recall submitting a Med Supp application where the company didn't issue the policy.