Clarification On The Special Election Period, Please

Ok, the Gordon might have been a bit cloudy on facts. Write it down folks... don't happen often.

2011 Choosing a Medigap Policy, page 14-15, and page 40. Medicare alone counts as creditable coverage ONLY when a person is buying a medigap plan during OE, other times, such as your client, you have to be replacing other coverage such as medigap, group health, MA, etc.

The facts probably got twisted in my mind since I seem to have several clients come to me T65 that have already been on Medicare for a while. I do remember one particular case that may have made this stick. Guy calls, his wife is DI Medicare, she is starting to have some seriously expensive treatments for RA. She is 64, nothing I can do. I tell him that when she T65s that she'll have OE and can get a plan. He's worried that it won't be covered. I read the referenced material (long time ago) to confirm that she will be 100% covered. Then it was the tough decision on who to place her with. I hate handing one of my top companies a expensive client like that.

So to clarify my earlier statements, Medicare alone acts as creditable coverage for those on Medicare A/B before they turn 65.

See, that is why I suggest everyone double check what is posted on internet forums. Good catch!

But, like Frank said, it is rare to have a claim denied for pre-x and most companies have removed it completely.
 
Ok, my situation - Man is 70, only on Medicare. Has a fall around Thanksgiving injuring his back - write him a PDP in December and on Feb 28th, write AARPUHC Plan F. Had to wait till this date until he has been out of the hospital 90 days so he can answer NO to both UHC questions.

I questioned UHC about pre-existing and they told me they would be covered. When reading the handbook, it says 90 day waiting period. I told my client this - which he conveniently forgot - so he had a procedure done to possibly relieve pain associated with this fall and UHC did not cover it b/c it was within 90 days of policy eff date which was March 1.

So UHC is not recognizing this statement? Keep in mind that having Medicare alone acts as creditable coverage.

He was not in open enrollment or guar issue but did have Medicare prior but UHC is not recognizing this as creditable coverage?

Good luck...but I doubt they will reverse their decision.
 
"Pre-existing conditions will be covered as of the AARP Medicare Supplement plan effective date for applicants who qualify for Open Enrollment or Guaranteed Issue [FONT=Corporate SBQ,Corporate SBQ][FONT=Corporate SBQ,Corporate SBQ](see pages 9 and 10) [/FONT][/FONT]or who are replacing a Medicare Supplement plan or creditable coverage.* For all others, there is a 3-month waiting period after the plan effective date before pre-existing conditions are covered.
[FONT=Corporate SBQ,Corporate SBQ][FONT=Corporate SBQ,Corporate SBQ]All decisions to cover pre-existing conditions will be made when the application is processed.
[/FONT][/FONT]* [FONT=Corporate SBQ,Corporate SBQ][FONT=Corporate SBQ,Corporate SBQ]Note: [/FONT][/FONT]Medicare Parts A and B are creditable coverage. However, individuals who buy Medicare supplement insurance are [FONT=Corporate SBQ,Corporate SBQ][FONT=Corporate SBQ,Corporate SBQ]keeping[/FONT][/FONT], not [FONT=Corporate SBQ,Corporate SBQ][FONT=Corporate SBQ,Corporate SBQ]replacing[/FONT][/FONT], Medicare Parts A and B."

Thanks Frank for the info - from the AARPUHC - Med supp "handbook" - so as I read this here, since he has had A and B, he should not have pre-existing? This is making my head hurt!!!
 
"Pre-existing conditions will be covered as of the AARP Medicare Supplement plan effective date for applicants who qualify for Open Enrollment or Guaranteed Issue [FONT=Corporate SBQ,Corporate SBQ][FONT=Corporate SBQ,Corporate SBQ](see pages 9 and 10) [/FONT][/FONT]or who are replacing a Medicare Supplement plan or creditable coverage.* For all others, there is a 3-month waiting period after the plan effective date before pre-existing conditions are covered.
[FONT=Corporate SBQ,Corporate SBQ][FONT=Corporate SBQ,Corporate SBQ]All decisions to cover pre-existing conditions will be made when the application is processed. [/FONT][/FONT]* [FONT=Corporate SBQ,Corporate SBQ][FONT=Corporate SBQ,Corporate SBQ]Note: [/FONT][/FONT]Medicare Parts A and B are creditable coverage. However, individuals who buy Medicare supplement insurance are [FONT=Corporate SBQ,Corporate SBQ][FONT=Corporate SBQ,Corporate SBQ]keeping[/FONT][/FONT], not [FONT=Corporate SBQ,Corporate SBQ][FONT=Corporate SBQ,Corporate SBQ]replacing[/FONT][/FONT], Medicare Parts A and B."

Thanks Frank for the info - from the AARPUHC - Med supp "handbook" - so as I read this here, since he has had A and B, he should not have pre-existing? This is making my head hurt!!!

Back from a week at the lake. Good times with friends and family.

FLgirl... you're still wrong. Read where it says "keeping, not replacing" parts A/B... that means in his situation he DOES NOT have creditable coverage per the publications I've referenced.

Why are we still talking about this?

AARP made a just decision for that claim. It will not be paid. End of story.
- - - - - - - - - - - - - - - - - -
Open a bottle of wine. It's after five somewhere. :D

Call if I can help.

Calling the Pope ain't helping this client. Claim denied due to pre-x... final word.
 
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Gee Gordon, I am not still talking about this - you are. I understand he is not covered for pre-existing.

"FLgirl... you're still wrong. Read where it says "keeping, not replacing" parts A/B... that means in his situation he DOES NOT have creditable coverage per the publications I've referenced."

Go back to the lake!
 
"Pre-existing conditions will be covered as of the AARP Medicare Supplement plan effective date for applicants who qualify for Open Enrollment or Guaranteed Issue [FONT=Corporate SBQ,Corporate SBQ][FONT=Corporate SBQ,Corporate SBQ](see pages 9 and 10) [/FONT][/FONT]or who are replacing a Medicare Supplement plan or creditable coverage.* For all others, there is a 3-month waiting period after the plan effective date before pre-existing conditions are covered.
[FONT=Corporate SBQ,Corporate SBQ][FONT=Corporate SBQ,Corporate SBQ]All decisions to cover pre-existing conditions will be made when the application is processed. [/FONT][/FONT]* [FONT=Corporate SBQ,Corporate SBQ][FONT=Corporate SBQ,Corporate SBQ]Note: [/FONT][/FONT]Medicare Parts A and B are creditable coverage. However, individuals who buy Medicare supplement insurance are [FONT=Corporate SBQ,Corporate SBQ][FONT=Corporate SBQ,Corporate SBQ]keeping[/FONT][/FONT], not [FONT=Corporate SBQ,Corporate SBQ][FONT=Corporate SBQ,Corporate SBQ]replacing[/FONT][/FONT], Medicare Parts A and B."

Thanks Frank for the info - from the AARPUHC - Med supp "handbook" - so as I read this here, since he has had A and B, he should not have pre-existing? This is making my head hurt!!!

I based my last post on this comment of yours.

A/B is not considered creditable for someone outside OE and not replacing other coverage. A/B is considered creditable coverage for those that have had A/B prior to T65.

Sorry to be harsh about the "why are we still talking... " comment. The publications referenced clearly spell it out and remove any/all confusion. It really does not matter what the AARP "handbook" says... the CMS pubs trump all.
 
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