Another Trial Right Question

[G.Gordon]

Yes, he is correct the trial is only for the 1st MAPD, if changed in AEP that right is given up. Wish I could find a link, but a couple of us ran into this last year. I don't think carrier's can change a CMS rule.

The CMS guidelines are the "minimum" rights a beneficiary has, the carrier can go above and allow a more liberal interpretation of the reg to suit them. Christian Fidelity, for example, used to take anyone, anytime, off of a MAPD if they have been on less than two years.

The Missouri GI law is another example. The law says same plan to same plan, F to F, for example. AARP allows a client to go from a G to F, C, N or any of their plans during their anniversary since they don't offer G. They are not required to at all.

 

[bluediamond]

You are right, the carrier can give a GI w/o their permission. I was wrong, don't know what got into me, but their trial right is over when going on another MAPD during AEP. We ran into it because the carrier I represent would not do it.

 

[Newby]

Yes, he is correct the trial is only for the 1st MAPD, if changed in AEP that right is given up. Wish I could find a link, but a couple of us ran into this last year. I don't think carrier's can change a CMS rule.

Carriers can choose to accept if it's beyond the rule. They just can't do less than the rule.

 

[TwoCents]

The CMS guidelines are the "minimum" rights a beneficiary has, the carrier can go above and allow a more liberal interpretation of the reg to suit them. Christian Fidelity, for example, used to take anyone, anytime, off of a MAPD if they have been on less than two years.

The Missouri GI law is another example. The law says same plan to same plan, F to F, for example. AARP allows a client to go from a G to F, C, N or any of their plans during their anniversary since they don't offer G. They are not required to at all.

I would love to have seen what elections Christian Fidelity was using.

And we seem to have 2 topics going: when can she leave the MAPD and when can she get GI. While a carrier can give GI for med sup whenever they want, they can't give elections whenever they want to leave MA/MAPD/PDP.

 

[SKJ58]

I don't think carrier's can change a CMS rule.

Oh but they do! Here's one for the books... I had a client on UHC mapd who just dropped off my commissions in April of this year. Called UHC and they wouldn't say anything but "he changed plans". I figured that he moved, one of the only ways he could drop plan after Feb 15. Sooo... Last week he calls me out of the blue. Says that he wants to go back on a mapd. I asked what he was on now, he said AARP supp. I asked how he got on a supp in April after the deadline to drop mapd. He said that he got something in the mail from them and thought it was from me since he had UHC with me. He called UHC and they dropped his mapd and put him on supp in April.

 

[G.Gordon]

I would love to have seen what elections Christian Fidelity was using.

And we seem to have 2 topics going: when can she leave the MAPD and when can she get GI. While a carrier can give GI for med sup whenever they want, they can't give elections whenever they want to leave MA/MAPD/PDP.

No, same subject being used in the context of the rigid interpretation of "Trail Right" and the possibility and occasions when companies have gone beyond the law to allow someone a Medigap under the Trail Right provision therefore making it "GI".

Note: Going beyond the law does not mean they did anything wrong, they did more than the law required.

 

[somarco]

Called Aetna yesterday about trial right.

Prospect T65 5/2015. Enrolled in MAPD. Few months later dx prostate cancer. OOP costs for treatment a surprise. 6 weeks daily radiation to start in Jan. Wants Medigap, G or N.

Wants Aetna.

Well ............

Their underwriting guide says no to G or N for GI. We talk some more. I answer his questions. Ask for a day to get response from Aetna.

Called Aetna. First response, no to G or N.

But that contradicts Mcare.gov. How can you do that?

We never offer G or N for GI.

May I send you the link so you can see what I am reading? Look at #4.
https://www.medicare.gov/find-a-plan/staticpages/learn/rights-and-protections.aspx

Yes, I see what you are saying but we don't allow G or N.

How can you do something different from what Mcare says the prospect can do? Would you run it up the flagpole and get back to me? Preferably via email so there is no question.

Sure.

10 minutes later got email.

Yes, he can enroll in any plan.

Shock.

 

[G.Gordon]

1. If their part B date is 5/1/2015 they are still OEP until 10/31. No trail right or GI consideration needed. If this were November then that member would have trail right to A,B,C,F,K, or L under trial right GI.

 

[somarco]

3/15, not 5/15.

Sleep deprivation impacting me. Still got 7 more weeks until I can sleep. But thanks for the info. Might be helpful in the future.