Hi everyone: My client Barry is 67 years old and has had a liver transplant and was put on disability and Medicare long before he turned 65. When he was still 64 he went onto his wife's Blue Cross employer group plan, with Blue Cross as primary and Medicare as secondary. (he was not my client when he did this) Now he is almost 67 and his wife is retiring and dropping her employer plan. Barry would like to enroll in a Plan G but now I'm wondering if he will be able to use his IEP and be automatically accepted into the Plan G because there is no way he is going to pass underwriting. What are this man's options as far as getting a Plan G since he turned 65 2 years ago but has used Medicare as secondary since he turned 65. Does that make any difference for him?
Medicare as Secondary situation
- Thread starter Nikita
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I will take a stab at this. Since the wife was an ACTIVE employee and now dropping the EGHP, it creates a GI situation for the husband. If his Part B started before 1-1-20, he could still qualify for F. If after that date, he could get a G through this GI situation.
The insuring company will want proof that the new mb has dropped the EGHP.
However, be warned that companies don’t like this business and so pay very little commission. But, it would be the right thing to do. I’ve done a couple like this and received a whopping $40/yr. You could also write the Part D which would have a true-up. ~ $40 x 2 = $80
You can find these in the Medicare & You handbook. Just Google “Medicare & You 2022”
In this situation, at least you will have the opportunity to offer the wife some options. If she wants a Med Supp and she is healthy, you can write her using Underwriting. If she is just adding the Part A/B or B NOW, that is a simple Open Enrollment situation, no UW required.
Good Luck.
Barry could have used turning 65 IEP to enroll in a Medigap two years ago, but that ship has sailed.
Barry has an SEP to enroll in MAPD or PDP but not Medigap . . . he has 2 months after losing EGH to enroll in MAPD or PDP
Special circumstances (Special Enrollment Periods) | Medicare
More on who pays first, second . . . pages 14 thru 18
https://www.medicare.gov/sites/defa...lth-benefits-your-guide-to-who-pays-first.pdf
Since EGH is primary and Medicare secondary, it does not seem the Medigap GI rights will apply
Guaranteed issue rights | Medicare
Barry has an SEP to enroll in MAPD or PDP but not Medigap . . . he has 2 months after losing EGH to enroll in MAPD or PDP
Special circumstances (Special Enrollment Periods) | Medicare
More on who pays first, second . . . pages 14 thru 18
https://www.medicare.gov/sites/defa...lth-benefits-your-guide-to-who-pays-first.pdf
Since EGH is primary and Medicare secondary, it does not seem the Medigap GI rights will apply
Guaranteed issue rights | Medicare
A lot of carriers will still issue it GI. I know MoO and UHC will as I've done it with both.
Which plan: G or F - I can't remember exactly without looking at the agent guides. UHC may require F and MoO may require G if I'm taking a guess.
Are you saying there not looking at the effective date of his part B? There just looking that he came off group coverage and acting like it’s an iep?
That is correct. Leaving group coverage only triggers GI for Medigap if (rarely) Medicare was primary to group. Too often, people have A&B even when Medicare is secondary (they got bad advice). Therefore, some carriers will still issue GI.
It's also technically involuntary. He is not retiring, his wife is, and his loss of coverage is collateral damage.
Carriers are free to have a more LIBERAL definition of GI (CMS guidelines) but can't be more stringent.
Haven't found a carrier (yet) that will issue G plan on someone who qualified for Medicare prior to 1/1/2020 . . . could be one, but I haven't seen it.
Some may not check to see if EGH or Medicare was primary . . . maybe because there really isn't a way to verify primary coverage . . . and letters of creditable coverage don't state primary/secondary (at least the ones I have seen).
I rarely take on GI cases because the carrier requirements for qualifying seem to be fluid. Also, most don't pay a commission for Medigap GI.
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