Another SEP question

[Winter_123]

Clients who leave a med sup for an MA have a right to go back to that MA as long as it is within 12 months (and their first time in an MA and so on). The carrier that I was with last enrollment period (big carrier, affiliated with a senior citizen lobbying group) was never able to give a clear answer to the question of whether they could go back anytime within 12 months or whether it still had to be within the AEP and not more than 12 months. The support line folks insisted that it still had to be AEP (please do not tell me it depends on who you talk to and whether they are a supervisor and so on. I rattled far more cages than any agent should have to. They are confused and worthless as tits on a nun at all levels).

However, the regional/territory sales manager type insisted that it could be anytime. In other words, a client enrolls in a MA in December but in June they decide they just want to go back to the med supp for no other reason other than that is what they want. Can do they that or do they need to wait until the next AEP. As an aside, I assume that if it an MAPD that they would have to pick up a PDP plan when they dropped the med supp but could drop that at the next AEP, yes/no?

Could someone slap me around a little and give me the right answer to these questions- ideally citing the source of their understanding.

Thanks.

Winter

 

[insurance0707]

I think the insurance companies are playing dumb on this one for a reason. They don't want their MAPD business rolled. That's obvious because of the lock in period. YOu don't have lock in with Med supps. If more agents knew there was a 12 month trial peroid the insurance companies would lose some of their business. Maybe they're not informing these people at the home office for a reason. Just a thought.

 

[GreenSky]

Clients who leave a med sup for an MA have a right to go back to that MA as long as it is within 12 months (and their first time in an MA and so on). The carrier that I was with last enrollment period (big carrier, affiliated with a senior citizen lobbying group) was never able to give a clear answer to the question of whether they could go back anytime within 12 months or whether it still had to be within the AEP and not more than 12 months. The support line folks insisted that it still had to be AEP (please do not tell me it depends on who you talk to and whether they are a supervisor and so on. I rattled far more cages than any agent should have to. They are confused and worthless as tits on a nun at all levels).

However, the regional/territory sales manager type insisted that it could be anytime. In other words, a client enrolls in a MA in December but in June they decide they just want to go back to the med supp for no other reason other than that is what they want. Can do they that or do they need to wait until the next AEP. As an aside, I assume that if it an MAPD that they would have to pick up a PDP plan when they dropped the med supp but could drop that at the next AEP, yes/no?

Could someone slap me around a little and give me the right answer to these questions- ideally citing the source of their understanding.

Thanks.

Winter

The correct answer is they may move back into their former Med Supp (or Mutual of Omaha due to their internal rules) within the 1st 12 months of being in their 1st MA plan. If it was an MAPD, they can also go into a PDP.

Has nothing to do with IEP, AEP, CIA, FBI - it's an SEP and it supersedes all the other crap.

Rick

 

[retread]

The correct answer is they may move back into their former Med Supp (or Mutual of Omaha due to their internal rules) within the 1st 12 months of being in their 1st MA plan. If it was an MAPD, they can also go into a PDP.

Has nothing to do with IEP, AEP, CIA, FBI - it's an SEP and it supersedes all the other crap.

Rick

Rick is correct (as always, errr most of the time)...

I should point out that there are two trial SEPs for MA beneficiaries, however. One is for a T-65 who elects an MA on first enrollment into Medicare. The second is for those who have a MedSup who choose an MA plan and change their mind within the first year. The rules about which plan they have access to is slightly different.

In both cases the SEP ends 12 months from MA enrollment. If they go beyond 12 months before they change their mind, it is too late in most cases. (I would bet they would argue that the agent mislead them and try for that approach though)

1) For 65s who never had a Med Sup, they can get ANY Med Sup available in their state at Guaranteed Issue.

2) For those who left their Med Sup and want to go back to it, they may as long as it is still available. (With the exception of older policies that included Rx benefits.) If their former plan is no longer available (carrier drops it or leaves area, etc.) they are limited to Plans A, B, C, F, K, or L, but can go with ANY carrier in their state in this scenario.

Note: IN MY OPINION> Under the second trial right, it is my contention that they do not HAVE to go back to their former policy, but may if they wish, as it is their RIGHT. However, they do not have Guaranteed Issue with any other carrier if their former policy is still available to them. As long as they can pass UW, they can get any Med Sup they choose. I know others on this forum will disagree with this last statement. So be it.

 

[Winter_123]

Rick is correct (as always, errr most of the time)...

I should point out that there are two trial SEPs for MA beneficiaries, however. One is for a T-65 who elects an MA on first enrollment into Medicare. The second is for those who have a MedSup who choose an MA plan and change their mind within the first year. The rules about which plan they have access to is slightly different.

In both cases the SEP ends 12 months from MA enrollment. If they go beyond 12 months before they change their mind, it is too late in most cases. (I would bet they would argue that the agent mislead them and try for that approach though)

1) For 65s who never had a Med Sup, they can get ANY Med Sup available in their state at Guaranteed Issue.

2) For those who left their Med Sup and want to go back to it, they may as long as it is still available. (With the exception of older policies that included Rx benefits.) If their former plan is no longer available (carrier drops it or leaves area, etc.) they are limited to Plans A, B, C, F, K, or L, but can go with ANY carrier in their state in this scenario.

Note: IN MY OPINION> Under the second trial right, it is my contention that they do not HAVE to go back to their former policy, but may if they wish, as it is their RIGHT. However, they do not have Guaranteed Issue with any other carrier if their former policy is still available to them. As long as they can pass UW, they can get any Med Sup they choose. I know others on this forum will disagree with this last statement. So be it.

Well there are some areas where people will disagree because the law is unsettled as far as how the fed regs interplay with state laws and regs.

Example. In my state you have guaranteed issue for med supp forever as long as you can show that you signed up at age 65 (or later if you had alternate coverage) and that there has been continuous uninterrupted coverage since then (no gap exceeding 90 days). In other words, if you have developed serious health issues you can still just switch to another carrier for a better rate. Problem is, a client goes over to an MA for a year but then wants to bounce back to a med supp. Yes, they have guaranteed issue back with their previous carrier but now they are locked in with the carrier (if they have serious health issues) and cannot take advantage of the ability to switch again because they have now had a 90 interruption in coverage. The feds do not have the authority to impose that on to state law since this is a state specific advantage. The DOI is contemplating introducing a law or rule change to clean it up but right now it is a don't ask-don't tell arrangement where the state is just relying on carriers not looking at it too deeply if the client says that they had continuous coverage.

The aforementioned worthless carrier related to the senior citizen lobbying group tells agents and clients that an MA constitutes creditable supplemental coverage under the state law. That is fine and dandy. Except, as you can imagine I am the type to just call the DOI's attorneys and ask them and they don't agree- obviously or they would not be contemplating introducing a change in regs.

Frigging nightmare. Anyway- The point is that it is hard to speak in general about some rights with MA's and reverting back to med supps because they are interwoven with state laws on the med supp side of the equation.

The 86 year old senior wants a one sentence explanation.
How about " I don't know."

Winter

 

[retread]

Well there are some areas where people will disagree because the law is unsettled as far as how the fed regs interplay with state laws and regs.

Example. In my state you have guaranteed issue for med supp forever as long as you can show that you signed up at age 65 (or later if you had alternate coverage) and that there has been continuous uninterrupted coverage since then (no gap exceeding 90 days). In other words, if you have developed serious health issues you can still just switch to another carrier for a better rate. Problem is, a client goes over to an MA for a year but then wants to bounce back to a med supp. Yes, they have guaranteed issue back with their previous carrier but now they are locked in with the carrier (if they have serious health issues) and cannot take advantage of the ability to switch again because they have now had a 90 interruption in coverage. The feds do not have the authority to impose that on to state law since this is a state specific advantage. The DOI is contemplating introducing a law or rule change to clean it up but right now it is a don't ask-don't tell arrangement where the state is just relying on carriers not looking at it too deeply if the client says that they had continuous coverage.

The aforementioned worthless carrier related to the senior citizen lobbying group tells agents and clients that an MA constitutes creditable supplemental coverage under the state law. That is fine and dandy. Except, as you can imagine I am the type to just call the DOI's attorneys and ask them and they don't agree- obviously or they would not be contemplating introducing a change in regs.

Frigging nightmare. Anyway- The point is that it is hard to speak in general about some rights with MA's and reverting back to med supps because they are interwoven with state laws on the med supp side of the equation.

The 86 year old senior wants a one sentence explanation.
How about " I don't know."

Winter

LOL! I feel your pain... In Missouri, where they have GI similar to CA, one can switch MedSups on the policy anniversary. The sad thing is that there is nothing to bar the carrier from having a rate table for GIs higher than initial issue.... and this is exactly what BX does. You want GI? Fine, you can have it.... but you pays fer it. How 'bout them apples? You want Standard rate? Go thru UW and don't complain to momma.