Calculating Open Enrollment

[Winter_123]

Med supp open enrollment obviously starts when client is both 65 and has part B.

My question is basic but nevertheless here it is:

Am I right in thinking that one can comply by signing up in that six month period even though the effective date for the applied-for policy is outside the six month period?

Or do they have to be effective during that period. I thinking that they have complied as long as they have submitted a valid application during that period even though the effective date may be further out.

What sayeth thee?

 

[bourbonlegend]

The application must be DATED within 6 months of the first day of the month you are BOTH 65 or older and enrolled in medicare part B.

The effective date can be outside of the 6 months.

 

[G.Gordon]

Supp open enrollment is six months before and six months after the beginning of the beneficiaries part B.

Say they have a Aug. 1 part B date. You can take an applicaton anywhere from Feb. 1 to July 31 for a Aug. 1st effective. Or... you can apply during any day of any of months of Aug - Jan 31st. The last day she is protected under the open enrollment is Jan 31 so her effective date would have to be 1/31/20xx at the latest. Any effective date outside of that would require underwriting.

 

[bourbonlegend]

Just got off the phone with Underwritting.

The policy can be effective 60 days from sign date and still be OE as long as policy was dated within OE.

 

[G.Gordon]

Just got off the phone with Underwritting.

The policy can be effective 60 days from sign date and still be OE as long as policy was dated within OE.

That may be true for "that" company, but you'll find that it's not true for all. I've had cases get hung up because we asked for an effective date of the 1st of the month. Refering to the above example say I asked for Feb. 1, 2010... that company (I can't remember which now) stated that we'd have to include the underwriting information.

 

[bourbonlegend]

Fair enough. The only reason why I posted in this thread is that I'm dealing with a case like this as we speak.

Lesson learned = If you are writing an OE case but need an effective date up to 2 months outside of OE then United of Omaha is your company.

 

[Russ]

Supp open enrollment is six months before and six months after the beginning of the beneficiaries part B.

Say they have a Aug. 1 part B date. You can take an applicaton anywhere from Feb. 1 to July 31 for a Aug. 1st effective. Or... you can apply during any day of any of months of Aug - Jan 31st. The last day she is protected under the open enrollment is Jan 31 so her effective date would have to be 1/31/20xx at the latest. Any effective date outside of that would require underwriting.

Not saying you're wrong, but in Florida AARP will only let you date an application up to 3 months before their Part B effective date....i.e., you can date one August 1st for a November 1st effective date.

United of Omaha will let you write someone up to 6 months before their part B effective date to make effective the date their part B starts.

 

[G.Gordon]

And both companies are right and staying within the law. Some companies like MOO will go above and beyond the law and some will do the bare minimum.

It's frustrating when you have multiple companies and they all have their "own way" to do things... and they're all right in the way they do it.

 

[Tom Highway]

Well here's a twist on this question for you all.

I'm still doing a good bit of MA. One couple that I am seeing is in a bind. They were on the wife's company health plan, but she retired in June. She had enough vacation to keep her work health insurance through the end of July, but she either has to use medicare or go on COBRA August 1.

Here's the problem. They both have red white and blue cards that show their Part A effective dates. They sent their letter of creditable coverage to medicare/ssa to get their part b effective dates, and were told that they would both have an august 1 part b effective date.

Problem is that with any marx check, neither of the two show a part b effective date. If it ain't verifiable, it doesn't exist.

So, I don't think I can enroll them in a MAPD plan effective August 1, can I?

I am appointed with Mutual of Omaha/United World. Is it possible to enroll them in the MOO med supp effective August 1? If they don't already have Part D, would this loss of creditable coverage qualify them for a Part D?

I guess I could call MOO tomorrow to find out, too.

 

[MrMack]

Problem is that with any marx check, neither of the two show a part b effective date. If it ain't verifiable, it doesn't exist.

So, I don't think I can enroll them in a MAPD plan effective August 1, can I?


They would stay pended until they get the Part B date from Medicare. The company would probably keep them 20-30 days. This could get them on the ball for getting Part B set up as quick as possible. Just let them know no coverge until Part B is confirmed.