Case Study.. Give Me Ideas, Class.

[G.Gordon]

59 male, 57 female on ss disability.

No medicare supplement.

Makes too much money to be on medicaid ($1200/mo) spend down.

Options:

a. Enroll them in BCBS's GI plan C @ $300/mo.
b. Encourage them to get a MAPD.
c. Enroll them in BCBS's GI plan C for one/two months then get them to enroll into a MAPD for one/two months therefore triggering GI laws for them to chose a cheaper and GI medicare supplement.
d. Leave it alone.

 

[DS4]

Do they need Rx coverage or do they both have a PDP now?

Another scenario would be,
E. Leave them on Medicare only and add PDP Jan 1st.

The $300/mo premium for Disability Med supp C in your state, is this for both? That is pretty good.
Is this a commission product?

 

[G.Gordon]

Do they need Rx coverage or do they both have a PDP now?

Another scenario would be,
E. Leave them on Medicare only and add PDP Jan 1st.

The $300/mo premium for Disability Med supp C in your state, is this for both? That is pretty good.
Is this a commission product?

They have a PDP.

The GI plan from BCBS is a commissionable product.

 

[Frank Stastny]

59 male, 57 female on ss disability.

No medicare supplement.

Makes too much money to be on medicaid ($1200/mo) spend down.

Options:

a. Enroll them in BCBS's GI plan C @ $300/mo.
b. Encourage them to get a MAPD.
c. Enroll them in BCBS's GI plan C for one/two months then get them to enroll into a MAPD for one/two months therefore triggering GI laws for them to chose a cheaper and GI medicare supplement.
d. Leave it alone.

Is their spend down $1,200 per month or is their combined income $1,200 per month? If they are trying to meet their spend down then they may need a supplement to put toward the spend down.

I would recommend a Med Supp especially if you would have to sell them a PFFS plan. But you know that I don't care for them.

If they can get an HMO then I might suggest they talk to another agent about signing up for that.

I would have to know more about them, their life style and what their disabilities are. I have talked to people on SS disability that were very healthy and had a very active life style. I would not recommend any kind of MA plan for them especially if they frequently leave the "network" area.

I met with a guy this fall who was cutting firewood when I got there. He is on SS disability because he had bypass surgery three years ago and claims he can no longer work. He even smiled when he said that. No, I didn't write a policy on him. It kind of annoyed me. (I'm holding back.) He was going to be using my tax dollars to pay the premium.

I don't think an agent can go wrong suggesting a Med Supp for a lot of the reasons I'm sure you already know.

 

[G.Gordon]

Both have considerable health concerns. He's sroked out a couple of times and has mobility issues because of it. They are well beyond their open enrollment window so that is why I'm suggesting the "other" means to get them to the supplement market via "tricks of the trade".

Their spend down is $1200/mo.

 

[DS4]

c. Enroll them in BCBS's GI plan C for one/two months then get them to enroll into a MAPD for one/two months therefore triggering GI laws for them to chose a cheaper and GI medicare supplement.

Do you have anything in your state similar to what we have in California?,
Yearly Anniversary or Birthday Rule

Once you have purchased supplemental coverage, you will have the opportunity every year on your birthday to switch to a like or lesser plan without underwriting. Thus, if you are enrolled in Plan F, then you can move to a new Plan F (or lesser plan) with a different insurance company. Consumers can lower their premiums by taking advantage of this rule every few years. This open enrollment window typically ends one month after your birthday and is sometimes referred to as the "anniversary rule."

 

[Frank Stastny]

Do you have anything in your state similar to what we have in California?,
Yearly Anniversary or Birthday Rule

Once you have purchased supplemental coverage, you will have the opportunity every year on your birthday to switch to a like or lesser plan without underwriting. Thus, if you are enrolled in Plan F, then you can move to a new Plan F (or lesser plan) with a different insurance company. Consumers can lower their premiums by taking advantage of this rule every few years. This open enrollment window typically ends one month after your birthday and is sometimes referred to as the "anniversary rule."

Yes, we do have a Guaranteed Issue Provision. Ours is on the anniversary data of the policy. However, with the companies I represent I can only move them to a like plan. I have not seen a company that will also allow me to move them to a "lesser plan".

I wish we did, I don't sell a Plan F and in Missouri a Plan F can be several dollars more per year than a Plan D. I recently saved a woman $57 per month by moving her from a Plan F with BX to a Plan D with National States. She is in love with me.

 

[DS4]

Yes, we do have a Guaranteed Issue Provision. Ours is on the anniversary data of the policy.

I would then recommend option C skipping the middle step. More them to GI plan C, calendar, and then more to a more affordable plan C during the GI anniversary window.

 

[Focus LTC]

I have talked to people on SS disability that were very healthy and had a very active life style.

That's FUNNY but not really

 

[radiusbob]

Special Needs Plan (SNP)?