- 7,790
I think Frank Stastny should weigh in on this one. I consider him the resident expert on Med Supps, etc.
Help! Sep problem
- Thread starter insurance0707
- Start date
Some companies are taking these trial #5's even if they were not the original med sup company. MoH/UW/MoO does.
Thank you for pointing out Trial #4, I had forgotten this and have been corrupted with misinformation.
Yes, that's always a possibility. It is up to the carrier in some cases, whether to accept them under GI or UW. They may interpret the trial right loosely in the client's favor, but they can never take away a client's rights.
As to the clients: They only have "rights" to GI for the same old policy. The other carriers may fight over this client.... I guess you would never know until you try.
And if the client does not WANT his old policy (still available), then he must submit to UW... yet he can get any policy he wants (subject to UW).
Only if his old policy is no longer available does his "rights" to other Med Sups kick in. In this case his "rights" (GI) are restricted to plans A,B,C,F,K, or L.... Then he does NOT have to answer health questions on those policies. If he wants a plan D... well, he is subject to UW.
- 7,066
Good to see your "face" again. We can always count on you for the "straight scoop".
We miss you here. Give me a call sometime.
- 1,908
Please read, "Medicare and You 2008" page 45.
Mmm, Mmm, any questions as to why Medicare beneficiaries are so confused about Medicare options?
Mmm, Mmm, any questions as to why Medicare beneficiaries are so confused about Medicare options?
This is the short version, and can be confusing if you don't have the long story. (Job security for agents)
Thanks for the invite.
I have been busy expanding my business into IFP and Group and building a web site. Boy, ...as if MA/Med Sups weren't enough to keep my nose in the books!!
I spend more time lurking on the forum than posting these days. Hard to tolerate put downs when you are trying your best to help others.... sometimes the exasperation is not worth it with so much other more important work needs to be done. This IS volunteer work, after all!
Your encouragement is like a drink of fresh water... Thanks.
- 7,066
You are definitely one of the "good guys" who really busts their ass to help prospects make a well informed decision.
If there were more agents like you we wouldn't have the reputation we have and seniors would feel secure that the insurance they have is really in their best interest.
You can be my "wing man" any day.
Or, hopefully, I yours.- 948
Here it is:
What Happens if You Drop Your Medigap Policy When You Join a Medicare Advantage Plan?
[FONT=PDDFL J+ Times New Roman PSMT,Times New Roman PSMT]In most cases, if you drop your Medigap policy, you won't be able to get it back. [/FONT][FONT=PDFDL I+ Times New Roman PSMT,Times New Roman PS]However, if this is the first time [/FONT][FONT=PDDFL J+ Times New Roman PSMT,Times New Roman PSMT]you have joined a Medicare Advantage Plan or other Medicare health plan, or bought a Medicare SELECT policy (a Medigap policy that requires you to use specific hospitals and, in some cases, specific doctors to get full benefits), you may have special Medigap protections. These protections give you a right to get your old Medigap policy back or buy a new one if you choose to leave your Medicare health plan within the first year. In either case, the new Medigap policy can't include prescription drug coverage. However, you may be able to join a Medicare Prescription Drug Plan if you join a Medicare Advantage Plan and leave it within the first year. Check with your State Health Insurance Assistance Program (SHIP) to see if your state offers other rights to buy Medigap policies. See pages 98–101 for the telephone number.
[/FONT][FONT=PDDLE I+ Frutiger,Frutiger]
As you can see, it says you "MAY" be able to join a PDP - it doesn't say that you CAN. I do know that providers like Coventry tell their reps that if the person dumps the MAPD within the 12 mos & it's not AEP or OEP, that they can buy a supplement, but can't enroll in the PDP. That's the provider talking - so I'm sure Humana has the same interpretation of this, which is why your client is being denied the PDP and being told it is not a SEP.
And - Hey Frank! Good to see you too. I'll give a call soon - just been busy (which is good!).
[/FONT][FONT=PDDLE I+ Frutiger,Frutiger]
[/FONT]
What Happens if You Drop Your Medigap Policy When You Join a Medicare Advantage Plan?
[FONT=PDDFL J+ Times New Roman PSMT,Times New Roman PSMT]In most cases, if you drop your Medigap policy, you won't be able to get it back. [/FONT][FONT=PDFDL I+ Times New Roman PSMT,Times New Roman PS]However, if this is the first time [/FONT][FONT=PDDFL J+ Times New Roman PSMT,Times New Roman PSMT]you have joined a Medicare Advantage Plan or other Medicare health plan, or bought a Medicare SELECT policy (a Medigap policy that requires you to use specific hospitals and, in some cases, specific doctors to get full benefits), you may have special Medigap protections. These protections give you a right to get your old Medigap policy back or buy a new one if you choose to leave your Medicare health plan within the first year. In either case, the new Medigap policy can't include prescription drug coverage. However, you may be able to join a Medicare Prescription Drug Plan if you join a Medicare Advantage Plan and leave it within the first year. Check with your State Health Insurance Assistance Program (SHIP) to see if your state offers other rights to buy Medigap policies. See pages 98–101 for the telephone number.
[/FONT][FONT=PDDLE I+ Frutiger,Frutiger]
As you can see, it says you "MAY" be able to join a PDP - it doesn't say that you CAN. I do know that providers like Coventry tell their reps that if the person dumps the MAPD within the 12 mos & it's not AEP or OEP, that they can buy a supplement, but can't enroll in the PDP. That's the provider talking - so I'm sure Humana has the same interpretation of this, which is why your client is being denied the PDP and being told it is not a SEP.
And - Hey Frank! Good to see you too. I'll give a call soon - just been busy (which is good!).
[/FONT][FONT=PDDLE I+ Frutiger,Frutiger]
[/FONT]
- Thread starter
- #30
- 1,240
Update on my client.....after many many many many phone calls and emails Humana has issued the PDP with a 7-1-08 issue date. CMS has also approved it.
People who took out an MAPD plan when they turned 65 do have the 12 month trial period where they can drop it and go back to Medicare, Medicare Supplement and a PDP plan on a guaranteed issue basis.
My suggestion to any of you is to send a copy of the SEP sheet or page 19 of Medicare along with a note explaining the SEP and your clients situation. When you provide the information in writing along with an explanation, I think it will help your case get issued the first time that it was sent in rather than calling and explaining, calling and explaining,
IT CAN BE DONE
People who took out an MAPD plan when they turned 65 do have the 12 month trial period where they can drop it and go back to Medicare, Medicare Supplement and a PDP plan on a guaranteed issue basis.
My suggestion to any of you is to send a copy of the SEP sheet or page 19 of Medicare along with a note explaining the SEP and your clients situation. When you provide the information in writing along with an explanation, I think it will help your case get issued the first time that it was sent in rather than calling and explaining, calling and explaining,
IT CAN BE DONE
