Eligible for Individual Plan when over 65??

[kstein]

So here is an interesting one.

Client is in NY and is self employed. Had a small business plan (husband t65 in May 2018, spouse is 70 and on A only, and secretary is 80 and on A only). Apparently they got audited and now the insurer, UHC, is dropping them eff 3/1.

This leaves the 70 and 80 year old with A only and enrollment into Part B under the GEP with a start date of 7/1.

Does anyone know of an option for these people to purchase plans asap to cover that gap? They are in zip 10065. The 70 year old may be able to do short term medical but the 80 year old is in very poor health and quite possibly on hospice.

Any thoughts would be appreciated!

 

[kgmom219]

Ugh

1. Get a 90 day supply on the drugs ASAP
2. Remind them they are covered on hospital, its doc charges that could be horrible. Hospice is mostly A.
3. Appeal at UHC. Not kidding. It may not work, but ask for a 4 month reprieve and see what happens.
4. If UHC says no, go to the NY DOI. See if they can help.

 

[DS4]

Had a small business plan

If they all had employer group health coverage, they can trigger Medicare Part B effective 3.1.18. Enroll in Med supps& Part D plans 3.1.18.

 

[bluediamond]

So here is an interesting one.

Client is in NY and is self employed. Had a small business plan (husband t65 in May 2018, spouse is 70 and on A only, and secretary is 80 and on A only). Apparently they got audited and now the insurer, UHC, is dropping them eff 3/1.

This leaves the 70 and 80 year old with A only and enrollment into Part B under the GEP with a start date of 7/1.

Does anyone know of an option for these people to purchase plans asap to cover that gap? They are in zip 10065. The 70 year old may be able to do short term medical but the 80 year old is in very poor health and quite possibly on hospice.

Any thoughts would be appreciated!

In answer to your question, yes they can get an individual plan but no subsidy. Unaffordable rates over 65.

Group dropping 3/1 they enroll now in Part B without the GEP.

 

[kstein]

In answer to your question, yes they can get an individual plan but no subsidy. Unaffordable rates over 65.

Group dropping 3/1 they enroll now in Part B without the GEP.

I should have mentioned it's only the 3 of them in the group so it isn't valid coverage for LEGHP SEP .

 

[DS4]

The L564 does not differentiate between small(under 20) and large(20+). A SEP is given for "employer group health plan". https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS-L564E.pdf
I would have them all take the completed L564 & 40B forms to Social Security.
What do they have to lose?? Some stupid SS worker will just rubber stamp their paperwork.
Otherwise, the age 70 and 80 year old will pay the +10%/year Part B late penalty.

 

[TN_agent]

My experience is the same as DS4's. I have had small group (less than 20) employees that enroll in B upon retiring all the time, have never had one rejected by Medicare or a part B LEP given if they can prove continuous employer coverage since age 65. The risk of not being on B and being in a small group isn't in being rejected by Medicare in enrolling in B when that coverage ends, the risk is that the employer's plan will only pay the 20% of part B claims that Medicare doesn't pay unless you are enrolled at age 65.

 

[DS4]

The question is, why didn't these employee's waive off the group at 65 and buy Med Supp's/Part D's? The employer could still pay their premiums. Employer wins and employee wins. I'm guessing the employer either didn't have an agent, or, a stupid agent.

 

[Devin01]

The real question is why the 70 and 80 year old never had b.

Not having b makes the clients all set to get a supplement and part d with the 40 and 56 forms. Medigap Open Enrollment and full commission

Looks like many sales are in your future.

Where in NY is client ? Anybody write another company in NY besides uhc.? Some companies allow cross border sales. Better commission then uhc

 

[LostDollar]

Open Enrollment
New York State law and regulation require that any insurer writing Medigap insurance must accept a Medicare enrollee’s application for coverage at any time throughout the year. Insurers may not deny the applicant a Medigap policy or make any premium rate distinctions because of health status, claims experience, medical condition or whether the applicant is receiving health care services. However, eligibility for policies offered on a group basis is limited to those individuals who are members of the group to which the policy is issued.

A list of insurers offering Medigap insurance along with the premium rates for each plan are provided below. Note that while every Medigap insurer offers both Plan A and B for policies sold before June 01, 2010, and Plans A, B and either C or F for policies sold on or after June 01, 2010, not every company offers all standardized plans.