Eligibility for medicare question

[GreenSky]

"Rick is correct." Feel better?

Thanks Frank. That was prozac to my ears.

Rick

 

[midwestbroker]

So to recap

GI Supp - 6 months after getting Part B or 63 days after leaving a credible coverage plan if they already had Part B in place

Is that correct?

 

[GreenSky]

So to recap

GI Supp - 6 months after getting Part B or 63 days after leaving a credible coverage plan if they already had Part B in place

Is that correct?

That's right as rain!

Rick

 

[Frank Stastny]

So to recap

GI Supp - 6 months after getting Part B or 63 days after leaving a credible coverage plan if they already had Part B in place

Is that correct?

Yes and NO.

The first months after getting Part B is called "Open Enrollment", not Guaranteed Issue even though the person is guaranteed to be able to get a Med Supp policy. I only point that out because it can be confusing to new agents. Guaranteed Issue is something that takes place after Open Enrollment has expired. ( I knew you knew that, it was for the new guys. lol)

A person can get a Med Supp policy "Guarantee Issue" if he already has Part B, his Open Enrollment period has expired, is leaving credible coverage like an employers group plan, and does not have the option to continue on the employers group plan.

In other words, the guy worked past 65, has Part B but stayed on the group plan, decides to retire at age 67 and the employer says that the group plan is not offered to retirees. He can get a Med Supp GI

If the retiree has the option of staying on the group plan but would rather have a Med Supp, then he cannot get a Med Supp under GI. He will have to answer health questions on the app.

The continuation of credible coverage must not be available any longer before the person can get a GI Med Supp.

Usually the Insurance Company will require documentation that credible coverage is no longer available.

 

[GreenSky]

A person can get a Med Supp policy "Guarantee Issue" if he already has Part B, his Open Enrollment period has expired, is leaving credible coverage like an employers group plan, and does not have the option to continue on the employers group plan.

If the retiree has the option of staying on the group plan but would rather have a Med Supp, then he cannot get a Med Supp under GI. He will have to answer health questions on the app.

Frank, I don't believe this is correct. Leaving a group plan does not have to be involuntary.

So I say to you, "Prove it."

Rick

 

[Frank Stastny]

Frank, I don't believe this is correct. Leaving a group plan does not have to be involuntary.

So I say to you, "Prove it."

Rick

All I know is what I have had happen to me and what I was told by the underwriting department at Continental Life when I called them earlier this afternoon.

My post reflects exactly what I have had happen and what Continental Life requires.

 

[craig_ritter]

Frank, I don't believe this is correct. Leaving a group plan does not have to be involuntary.

So I say to you, "Prove it."

Rick

I think Rick is correct on this. The SEP provision for Medicare Advantage is handled differently, which is where I think the confusion lies.

There is no requirement (that I'm aware of) that the loss of coverage be INVOLUNTARY for the MEDICARE SUPPLEMENT GI provision to take effect.

However, if you are talking about an SEP for a Part D election or an MA-PD election (loss of Creditable coverage), then the loss must be involuntary or, I believe, during the annual enrollment during the former employer group's plan annual election period (generally, this is around the first of the year, so this would coordinate with the AEP for Medicare, anyway). Effectively, this means that 99 times out of 100, it would HAVE to be involuntary (again, I'm talking SEP for Part D or MA-PD).

I hope this makes sense and provides some clarity. This is pretty detailed, I could provide some links to sources if anyone would like to review the regs for themselves, I just don't have time right now!

Craig

 

[Frank Stastny]

I think Rick is correct on this. The SEP provision for Medicare Advantage is handled differently, which is where I think the confusion lies.

There is no requirement (that I'm aware of) that the loss of coverage be INVOLUNTARY for the MEDICARE SUPPLEMENT GI provision to take effect.

However, if you are talking about an SEP for a Part D election or an MA-PD election (loss of Creditable coverage), then the loss must be involuntary or, I believe, during the annual enrollment during the former employer group's plan annual election period (generally, this is around the first of the year, so this would coordinate with the AEP for Medicare, anyway). Effectively, this means that 99 times out of 100, it would HAVE to be involuntary (again, I'm talking SEP for Part D or MA-PD).

I hope this makes sense and provides some clarity. This is pretty detailed, I could provide some links to sources if anyone would like to review the regs for themselves, I just don't have time right now!

Craig

Craig, I believe it is a matter of semantics and how the statement in interpreted.

This is what apparently causes the confusion. "3. There is a guarantee issue within 63 days for loss of employer group, COBRA and/or retiree benefits." Loss, the word loss is used not, "elected not to take". One will lose COBRA after either 18 or 36 months. Adding COBRA to that statement even further confuses the issue.

Unfortunately both of our opinions and Rick's are just that, opinions. Apparently each insurance company will make the determination they think is in keeping what what the statement means.

I have been told by underwriting at Continental Life that the term "loss" refers to the coverage no longer being available for the retiree as in the employer saying once you leave you are no longer entitled to benefits.

Their position, and I have to abide by it if I write policies for them, is if coverage is available and the retiree is electing not to keep it that the retiree is not entitled to GI of a Med Supp.

As far as Continental Life is concerned it really doesn't matter who is "right or wrong". That's their position and they are sticking to it.

We can discuss this all day long but none of us are the underwriter with any insurance company or the person who wrote the language so what we believe or don't believe is correct is really a mute point.

I have to abide by the interpretation of the companies I write for.

 

[senior-advisor-indiana]

Senior-Advisor-Indiana,

You are absolutely correct. Thes other guys do not seem to know what they are talking about. You are the man SAI.

 

[senior-advisor-indiana]

Wow, thanks!
By the way, I have to thank Rick also for backing up my points. I think I am gonna work for that guy.