No Plan G for You

[MBSC]

...I just don't know how they have avoided MACRA guidelines.

MACRA guidelines only grant D & G to those who become eligible in 2020+. States and Carriers have the option of being more generous but it is not required, so they aren't "avoiding" anything.

Seems to be arbitrary from carrier to carrier and state by state.

Now you got it! States and Carriers have the option of being more generous and let older benes have G and/or N. For carriers, it's possible for older GI benes to have G in some states but not others.

I have submitted 3 GI apps this year, all for folks on Medicare A & B prior to 1/1/2020. All submitted to the same carrier. Two approved, one denied.

They do need to be consistent if it's the same carrier, same state, all in 2020, and all with the same plan letter.

UHC lists their GI rules for Georgia on page 23 of this application package. If you could find a similar document for your carrier and compare it to what they are actually doing, it would be a start.

2020 UHC Georgia Medigap: https://www.aarpsupplementalhealth.com/content/dam/EAP/GA_AARP_Med_Supp_Enrollment_Kit_C.pdf

For those who may not know, HD-F has always been GI since it's an F. HD-G is now GI for certain enrollees because it's a G. When CMS refers to F, they mean both versions unless they state otherwise. The same now applies to G.

"Section 12. Guaranteed Issue for Eligible Persons

E. Products to Which Eligible Persons Are Entitled. The Medicare supplement policy to which eligible persons are entitled under:

(1) Section 12B(1), (2), (3) and (4) is a Medicare supplement policy which has a benefit package classified as Plan A, B, C, F (including F with a high deductible), K or L offered by any issuer."

Source (from 2009): Medicare Program; Recognition of NAIC Model Standards for Regulation of Medicare Supplemental Insurance

 

[somarco]

They do need to be consistent if it's the same carrier, same state, all in 2020, and all with the same plan letter.

NEED TO BE does not compute with this carrier.

One client, age 69, had A & B plus EGHP since T65. Retired, involuntary loss of coverage. Applied for and was given plan G.

Other two, husband and wife, had MAPD. Both age 72. Moved out of service area. Applied to same carrier as above. One was given G, the other would only be offered F, A or N.

I asked what I should tell the spouse who was not offered a G plan.

Crickets . . .

HD-F has always been GI since it's an F. HD-G is now GI for certain enrollees because it's a G.

More than one carrier said no to HDF in the past. I did find one who suggested HDF and my client took it.

@MBSC you are a wealth of information.

Unfortunately many of the carriers operate on the fly, making up their own rules as they go.

 

[kstein]

Check the GI chart with Anthem. They view losing eghp as a different opportunity than moving sep.

 

[MBSC]

One client, age 69, had A & B plus EGHP since T65. Retired, involuntary loss of coverage. Applied for and was given plan G.

Other two, husband and wife, had MAPD. Both age 72. Moved out of service area. Applied to same carrier as above. One was given G, the other would only be offered F, A or N.

The loss of EGHP SEP can have different carrier rules than their MAPD move SEP so a comparison cannot be made. The following is from page 13 of the Anthem Georgia paper application. If that is your carrier, a Plan G app should not have been submitted for the move SEP since they turned 65 prior to 2020. It slipped through the cracks.

"Guaranteed issue right situation:

#1: You have a Medicare Advantage Plan, (like a HMO or PPO) and your plan is being discontinued or you move out of the plan’s service area.

If you turned 65...
•Prior to 1/1/2020, Plan A or F. In addition, Anthem allows you to enroll into Plan N.
•On or after 1/1/2020, Plan A or G. In addition, Anthem allows you to enroll into Plan N.

#2: You have Original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare and that plan is involuntarily ending.

If you turned 65...
•Prior to 1/1/2020, Plan A or F. In addition, Anthem allows you to enroll into Plan G or N.
•On or after 1/1/2020, Plan A or G. In addition, Anthem allows you to enroll into Plan N."

 

[selfgen]

but not yet enrolled" is this referring to Medicare itself or a Medigap plan?

“Enrolled” used here refers to Medicare itself, not the Medigap policy. You do not “enroll” in a Medicare supplement , rather you are a “policyholder”. Just a distinction I am making.

whenever I am explaining the difference between Medigap and MAPDs, I always mention how with MAPD you are “enrolled” and you a member of a plan, a plan with certain benefits and rules that , as a member you agree to, whereas with a supplement, you are simply a policyholder, whereby you’ve made an individual agreement with the insurance company to pay your claims in exchange for your premium.

 

[LostDollar]

MACRA guidelines only grant D & G to those who become eligible in 2020+. States and Carriers have the option of being more generous but it is not required, so they aren't "avoiding" anything.


Now you got it! States and Carriers have the option of being more generous and let older benes have G and/or N. For carriers, it's possible for older GI benes to have G in some states but not others.

They do need to be consistent if it's the same carrier, same state, all in 2020, and all with the same plan letter.

UHC lists their GI rules for Georgia on page 23 of this application package. If you could find a similar document for your carrier and compare it to what they are actually doing, it would be a start.

2020 UHC Georgia Medigap: https://www.aarpsupplementalhealth.com/content/dam/EAP/GA_AARP_Med_Supp_Enrollment_Kit_C.pdf

For those who may not know, HD-F has always been GI since it's an F. HD-G is now GI for certain enrollees because it's a G. When CMS refers to F, they mean both versions unless they state otherwise. The same now applies to G.

"Section 12. Guaranteed Issue for Eligible Persons

E. Products to Which Eligible Persons Are Entitled. The Medicare supplement policy to which eligible persons are entitled under:

(1) Section 12B(1), (2), (3) and (4) is a Medicare supplement policy which has a benefit package classified as Plan A, B, C, F (including F with a high deductible), K or L offered by any issuer."

Source (from 2009): Medicare Program; Recognition of NAIC Model Standards for Regulation of Medicare Supplemental Insurance

NEED TO BE does not compute with this carrier.

One client, age 69, had A & B plus EGHP since T65. Retired, involuntary loss of coverage. Applied for and was given plan G.

Other two, husband and wife, had MAPD. Both age 72. Moved out of service area. Applied to same carrier as above. One was given G, the other would only be offered F, A or N.

I asked what I should tell the spouse who was not offered a G plan.

Crickets . . .



More than one carrier said no to HDF in the past. I did find one who suggested HDF and my client took it.

@MBSC you are a wealth of information.

Unfortunately many of the carriers operate on the fly, making up their own rules as they go.

(Caveat, not an agent)

This page
New Era Life

Shows New Era saying HDF is an eligible GI plan (At least for a switch back from MA).

Voluntary Disenrollment from a Medicare Advantage plan must be within the first 12 months of their first time enrolled in a Medicare Advantage plan. It is not "guaranteed issue" if they have been enrolled longer than 12 months. Only Plans A, B, C, F (including High Ded F) are available for guaranteed issue.

I know assumptions are dangerous, but I think one might be able to extend from that and say New Era would consider HDG GI for the newer medicare beneficiaries not eligible for HDF.