Affordable Care Act and Medicare PreX

Mar 10, 2016

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  1. BillyC
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    "Under the ACA neither Original Medicare or Supplemental Medicare (like Medigap) can deny coverage for preexisting conditions. Just make sure to enroll during initial enrollment periods and to switch plans at the correct enrollment and disenrollment periods to avoid any potential barriers to getting coverage (such as late fees for missing enrollment periods)."


    Can Medicare Policies Deny Preexisting Conditions? - Obamacare Facts


    Where can I find the real proof that this is true? I'm a young (very young) agent who is having hard time getting seniors to trust my statements, and need legal proof for just about everything i say.
     
    Last edited: Mar 10, 2016
    BillyC, Mar 10, 2016
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  2. somarco
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    somarco GA Medicare Expert

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    They could have worded this better.

    Medigap plans don't issue policies that "carve out" a p-x condition but they can and do refuse to issue a policy to someone with specific p-x conditions.

    Also, Obamacare applies to primary coverage health insurance plans, not secondary or supplemental plans.
     
    somarco, Mar 10, 2016
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  3. vic120
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    Wow how do they get away with saying that?

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    Especially since they use the words obamacare Facts all over the place
     
    vic120, Mar 10, 2016
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  4. somarco
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    Surely you don't believe the term Obamacare "facts" make it true.
     
    somarco, Mar 10, 2016
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  5. vic120
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    No but many who are not in the buis would. In Fact many who are not in the buis may think this is a govt site


    If any of us misled in such a way, we would probably have the hammer of CMS on us
     
    vic120, Mar 10, 2016
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  6. somarco
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    I imagine there are quite a few things on that site that are not completely accurate.
     
    somarco, Mar 10, 2016
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  7. BillyC
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    I actually called an underwriter who told me that beccause of the ACA, they typically don't run screenings for Preexisting, if a policy has already been issued.

    Then i asked the underwriter if they could direct me to a source and they of course couldn't. So that's what I found on line with a quik search.

    BTW that was equitable underwriter and 2 MOO underwriters.


    Edit: I want to be clear. Here's where I'm coming from. I had a Prospect who wanted to switch Medigap to save money. He was coming off of a plan F to a plan G. NOW in the "Choosing a Medigap Policy" from CMS, on pg 33, it states that if you've had a medigap plan for more than 6 months and you switch to a plan with the same benefits they can't write preexisting, elimination probationary..etc that's not verbatim. that's from what i can remember.

    Anyway.. the key point is same benefits. F and G are a bit different. would that matter?
     
    Last edited: Mar 10, 2016
    BillyC, Mar 10, 2016
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  8. somarco
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    somarco GA Medicare Expert

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    Most underwriters have no clue how to even spell ACA much less understand the law.
     
    somarco, Mar 10, 2016
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  9. BillyC
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    Sorry, I forgot to mention, They also tranferred me to their claims division to ask about that, and they told me the same thing. The guys who file the claims man! what the heck. i'm scared for my prospects now too!
     
    BillyC, Mar 10, 2016
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  10. somarco
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    Just because it is their practice to refuse post-issue underwriting does not mean that is required by law. Post-issue underwriting has always been a concern with primary payers but supplemental plans have so little exposure it really doesn't matter.

    Equitable allows me to see claim summaries for my existing clients. It always amazes me how little they pay.

    Rescission's are still possible for health insurance, including primary payers. What Obamacare outlawed were retroactive rescission's.

    Post-issue underwriting, and rescission, is permissable with Medigap. If the carrier chooses to ignore that option I don't see any major impact on loss ratio's.
     
    somarco, Mar 11, 2016
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