Enrolled in MA - Big Mistake

[somarco]

Got a call from a couple. Late 70's. Told me that "someone from Humana" called late last year and "upgraded" their coverage . . . from a supplement to MA.

Apparently they just figured out what they have. And they are not happy.

I know they can't change now, but . . .

They don't know if they were talking to an agent or Humana home office employee. They feel like they were "tricked". Is there any way to unwind this with CMS assistance or are they stuck until AEP?

This is all the information I have. Questions were answered "I don't remember" or "I don't know".

 

[axeman462]

Yes, have them complain to CMS, saying the agent lied to them. CMS will investigate the agent, give him a Section A violation, and Grant the old people an SEP. The process should take 3-6 months, depending on how much the agent fights back.

 

[JimmyCrappedCorn]

Got a call from a couple. Late 70's. Told me that "someone from Humana" called late last year and "upgraded" their coverage . . . from a supplement to MA.

Apparently they just figured out what they have. And they are not happy.

I know they can't change now, but . . .

They don't know if they were talking to an agent or Humana home office employee. They feel like they were "tricked". Is there any way to unwind this with CMS assistance or are they stuck until AEP?

This is all the information I have. Questions were answered "I don't remember" or "I don't know".

I see this happen at least a couple times every year. Simply put they got greased. The CMS is on the Medicare Advantage companies backs for a good reason but it is still not enough. I would tell them they can call Medicare or CMS or the Department of Insurance and cry but leave me out of it. I don't have time for it nor do I want to roll in the dirt. If they are my clients and they are healthy I say "Hey the year is almost half way over so just hang with it and I will get back with you in November and set you back up in your medicare supplement again." Now if they are unhealthy or not my clients I tell them to call Medicare and then I scoot out of the picture fast. Never play policeman or investigator because there is just no money in it.

 

[vic120]

I had a client call me last month, I have her on medsupp with AARP in NY, She has Epic though NY so she can change

She told me she might have made a mistake she said she thinks she might have enrolled in a humana plan after talking to an agent, That she loves the plan but didn't mean to enroll unless she enrolled with me as an agent.

She said she called and canceled (as it had not taken effect yet)so I checked with Silver Script and made sure her drug plan knew and stayed in effect

Then The next month we set up a call to go over the Humana plan and check her doctors and go over benefits.

Found out they told her almost all doctors will take the plan and all hospitals are in the network (lie)

Then going through the benefits they told her the hospital copay is 5 day per year not 5 days per stay

She stopped me there and said she would never had even thought about the plan had they not lied and she is staying on the supplement.

We didn't even get 25% through the summary

 

[Speck]

I believe there is an SEP for people who have left a supplement to go with a MAPD for the first time and it's within the first 12 months to switch back to the same plan that they were with. Would probably be a "guaranteed" situation which with most companies only pays 1% or less.

 

[vic120]

I believe there is an SEP for people who have left a supplement to go with a MAPD for the first time and it's within the first 12 months to switch back to the same plan that they were with. Would probably be a "guaranteed" situation which with most companies only pays 1% or less.

On those if the can pass underwriting I sell G, AARP however will GI plan G but other can get full % underwriting

 

[LostDollar]

I believe there is an SEP for people who have left a supplement to go with a MAPD for the first time and it's within the first 12 months to switch back to the same plan that they were with. Would probably be a "guaranteed" situation which with most companies only pays 1% or less.

That became an "education project" for me so I went hunting on medicare.gov to find the support.

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

It looks like option 5 trial right.

Would this be a situation where taking a GI commission hit would be worthwhile in terms of: "looking brilliant" could generate some referrals?

 

[LostDollar]

On those if the can pass underwriting I sell G, AARP however will GI plan G but other can get full % underwriting

Looking at the table I linked to, it looks like that would work with trial right 4, but doesn't Somarco's situation go with options 5 or 7? And would that leave him with the possible option of getting them back in their original Humana plan with no commission to him, or selling them a plan F with some other carrier?

 

[vic120]

Looking at the table I linked to, it looks like that would work with trial right 4, but doesn't Somarco's situation go with options 5 or 7? And would that leave him with the possible option of getting them back in their original Humana plan with no commission to him, or selling them a plan F with some other carrier?

Carriers interpret differently, Most will give GI for plan F < i believe there are a couple who don't, (don't remember who though) AARP will give GI on any plan and up to 2 years (If they still do the 2 years not sure but they did)

Which is different then the way it reads going back to same company same plan

 

[LostDollar]

Ok, thanks.