Clarifying the Right to Return to Medigap After 1 Year on MAPD

[Mink]

Here is the rule:
"If you join a Medicare Advantage Plan for the first time, and you aren’t happy with the plan, you’ll have special rights to buy a Medigap policy if you return to Original Medicare within 12 months of joining."

I just want to confirm it is only during the next AEP. I have a client that says if she signs up now and if she does not like it, she can change back to the old Medigap policy in April for instance. Thoughts?

 

[WCMason]

Here is the rule: "If you join a Medicare Advantage Plan for the first time, and you aren’t happy with the plan, you’ll have special rights to buy a Medigap policy if you return to Original Medicare within 12 months of joining." I just want to confirm it is only during the next AEP. I have a client that says if she signs up now and if she does not like it, she can change back to the old Medigap policy in April for instance. Thoughts?

Your client knows more than you do about how the trial right works.

 

[sman]

Here is the rule:
"If you join a Medicare Advantage Plan for the first time, and you aren’t happy with the plan, you’ll have special rights to buy a Medigap policy if you return to Original Medicare within 12 months of joining."

I just want to confirm it is only during the next AEP. I have a client that says if she signs up now and if she does not like it, she can change back to the old Medigap policy in April for instance. Thoughts?

They can exercise the trial right at any time during those 12-months. Not just during AEP.

Also, they generally have to go back to their old Med Supp unless it is no longer offered. At that point they can go to a new carrier. However, some carriers are requiring proof that the old Medicare Supplement is no longer available before they will write a new Med Supp on a GI basis.

 

[somarco]

And ......... most carriers pay $0 or almost nothing on GI.

If your new client exercises his/her trial right and goes back to the old plan you lose on that too unless you were the old agent.

Here are the GI rights, including trial right. I refer to this quite often because I don't trust my memory.

http://www.medicare.gov/find-a-plan/staticpages/learn/rights-and-protections.aspx

 

[cadylou]

True - the way the rule reads you can do it at any time. What Ive had happen during a period outside of AEP, is that sometimes we have had trouble "disenrolling" from an MAPD, since that "rulebook" on what constitutes a special election for doing so, doesn't recognize the Med sup rule. Also had one case where I managed to get the disenrollment accomplished, but was not able to get the standalone drug plan enrolled, since this situation also wasn't recognized as a special enrollment. People at the companies for the drug plans and MAPD plans didn't seem to understand how to process and really were hard to deal with on this. It's just cleaner if they can exercise their trial right on a calendar year basis to coincide with AEP - although I know that may not always be possible.

 

[jbage007]

The question, it seems, is not when one can go back to a med sup plan, but rather, when can a client get out of the MA PD plan they decided they did not like.

Dealt with this very issue just this week. Learned that Mutual of Omaha also insists that the client must go back to the exact same plan, meaning they must go back to plan F; they are prohibited from switching to plan G.

Since these folks are moving back to their home state of Washington, and therefore will automatically get disenrolled from their MAPD, the issue never arose as to whether they would be able to get out of their MAPD, but very interesting question, for sure.

 

[WCMason]

The challenge I have found is in submitting the Part D enrollment intended to cancel the MA plan during a trial right. One carrier in particular does not know this SEP exists and denies every enrollment without submitting to CMS. If this plan comes up as lowest overall for my client, I know I'm going to have to do battle with several layers of supervisors before I get to someone who can issue the Part D, therefore cancel the MA. I even included with the application a page from the Medicare Prescription Drug Manual describing this SEP. No help.

 

[G.Gordon]

The question, it seems, is not when one can go back to a med sup plan, but rather, when can a client get out of the MA PD plan they decided they did not like.

Dealt with this very issue just this week. Learned that Mutual of Omaha also insists that the client must go back to the exact same plan, meaning they must go back to plan F; they are prohibited from switching to plan G.

Since these folks are moving back to their home state of Washington, and therefore will automatically get disenrolled from their MAPD, the issue never arose as to whether they would be able to get out of their MAPD, but very interesting question, for sure.

They are not "prohibited", they are just not GI.

 

[jdeasy]

The question, it seems, is not when one can go back to a med sup plan, but rather, when can a client get out of the MA PD plan they decided they did not like.

Dealt with this very issue just this week. Learned that Mutual of Omaha also insists that the client must go back to the exact same plan, meaning they must go back to plan F; they are prohibited from switching to plan G.

Since these folks are moving back to their home state of Washington, and therefore will automatically get disenrolled from their MAPD, the issue never arose as to whether they would be able to get out of their MAPD, but very interesting question, for sure.

What you are describing is not a trial period disenrollment. That's a moving out of the plan's service area disenrollment. They don't have to go back their previous med sup plan even if it's available. They are GI into any company in the state as long as they got plans, A, B, C, F, K or L.

As Gordon said, they can get a plan G but it will be underwritten.

On the topic of the thread, the trail right used to say that you had to go back back to the plan you were on if "available".

Even though Standardized plans or MoO's plan N wasn't available anymore they were taking the position of making it available just to screw those people. {Isn't MoO just wonderful??}.

CMS changed the wording to "sold in your state..." just because of those shenanigans.

 

[jbage007]

It was a trial right situation, but then they remembered why they dropped their mutual of Omaha plan F in the first place. It was costing about $500 a month total for both of them combined. So as part of their thinking process, they considered moving back to Washington state. Turns out that the same plan F with Mutual of Omaha is about half the price in Washington state as it is here, which led them to the conclusion that moving back to their original home state may in fact be the best possible move.

So yes, in this situation if they move, they would be disenrolling from an MA PD plan due to out of service area move. I am only presuming that the state of Washington offers some sort of guarantee issue rights for med sup's based on moving back to the state. One thing is for damn sure, those rights do not exist in our state. You move here and you want to get guaranteed issue med sup, ha ha, ain't going to happen. Redneck and proud of it. That's our motto.

If they were to stay in this state and go back to mutual of Omaha under trial rights, they would in fact be prohibited from switching to any plan other then plan F which was their old plan with Mutual of Omaha, because they are totally uninsurable.