#4 Trial Right...............................

[agentjhc]

"#4: (Trial Right) You joined a Medicare Advantage Plan or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare."

"Any Medigap policy that is sold in your state by any insurance company."

So, a guy went on Med Adv 02/2016--first eligible, if he wants to switch for 01/01/2017 to a Med Supp he would be eligible. Am I interpreting this correctly?

 

[somarco]

Keep in mind Trial Right is considered GI when it comes to your compensation.

 

[agentjhc]

Keep in mind Trial Right is considered GI when it comes to your compensation.

Yeah....forgot that part. A couple of folks that after my masterful presentation still went with a Humana HMO @ $47 per month and now the HMO, and LPPO in the county is being dropped and a $80 RPPO is their new option, or the Care Improvement Plus that has the network the size of a Cheerio (and 2 MOOPs one for In and one for Out of Network). CIGNA-HS is in the CMS jail.

 

[G.Gordon]

If their plan is non-renewing then they are GI and you don't have to worry about the trial right. If they can pass underwriting that may help with the compensation. Keep in mind, AARP pays the same for either OEP, GI, or UW. They also offer Plan N as GI in addition to the CMS required A B C F K L.

 

[agentjhc]

If their plan is non-renewing then they are GI and you don't have to worry about the trial right. If they can pass underwriting that may help with the compensation. Keep in mind, AARP pays the same for either OEP, GI, or UW. They also offer Plan N as GI in addition to the CMS required A B C F K L.

Good point. Hopefully I can move them to a Med Supp--a couple are borderline LIS--and balked at the N premium the first time. These folks are in GA and AARP is fairly high.

 

[WCMason]

"#4: (Trial Right) You joined a Medicare Advantage Plan or Programs of All-inclusive Care for the Elderly (PACE) when you were first eligible for Medicare Part A at 65, and within the first year of joining, you decide you want to switch to Original Medicare."

"Any Medigap policy that is sold in your state by any insurance company."

So, a guy went on Med Adv 02/2016--first eligible, if he wants to switch for 01/01/2017 to a Med Supp he would be eligible. Am I interpreting this correctly?

If that MA was the prospects first plan when first eligible for Part A at 65, then yes. If the prospect postponed Medicare for some reason--job, for example--then applied for that MAPD after Part A was no longer new, then no.

 

[agentjhc]

Finding affordable coverage is difficult for a lot of folks with household incomes of $25-35,000 a year. They do not qualify for extra help and find the cost of a Plan N and PDP to be "too much" but don't know how they would come with $1288 to get in the hospital and all the expenses of a heart attack, stroke, cancer, but just know they can't afford Plan N and PDP.

 

[TN_agent]

Finding affordable coverage is difficult for a lot of folks with household incomes of $25-35,000 a year. They do not qualify for extra help and find the cost of a Plan N and PDP to be "too much" but don't know how they would come with $1288 to get in the hospital and all the expenses of a heart attack, stroke, cancer, but just know they can't afford Plan N and PDP.

Exact conversation I had with a T65 today. Married couple, income is $30,000 including Social Security. Some in savings, not a lot. Here's the thing, though. He is coming off of a highly subsidized Obamacare plan (he and wife on $1500 MOOP plan for about $150 a month for them both). The wife had an issue earlier this year and they said they did have trouble coming up with the $900 to pay the bill.

The federal government won't include the Medicare premiums he is paying when calculating what the household (younger wife) can afford to spend on health insurance for subsidies. So, it really is likely he can't afford the $122 pt B plus the $80 N plus the $20 PDP PLUS the $150 a month his wife's insurance will cost for the rest of 2016 plus 2017 until she goes onto Medicare 1-1-2018.

That would be paying 15% of gross household income on health insurance premiums. For someone at this income level, that is a lot. They have to have the cash for known expenses.

So, we ended up going with an MAPD for him. I am going to sell him a hospital indemnity on top of a decent MAPD (low MOOP for around here, he is happy with network-better than the Obamacare plan he is on now). His health is OK, so we may revisit later, but that is the best we can do for now.

 

[somarco]

I am going to sell him a hospital indemnity

Overall greater risk is outpatient exposure, not hospital. How do you plug that hole?

 

[TN_agent]

I explained everything to him, he owes 20% for chemo, 20% DME, etc, his exact words "well, we'll cross that bridge when we come to it". The Max OOP isn't horrible.

It boils down to trying to balance his budget with his risk/risk tolerance. Both he (and his wife eventually) paying for B+ N+ D = at least 20% of his limited budget every month. He doesn't consider that affordable and wanted the MAPD. Best I can do for now.