Enrolling in a terminating MA plan to get GI

[Special Agent]

i have a client in Fl on MA that wants to get Med supp but was previously declined by UHC for cardio issue.He asked about enrolling in a Cigna PPO that's terming 12/31 for 12/1 effective date using the FEMA sep so he could get GI.he would enroll himself in Cigna PPO on medicare website.Will this work? Is UHC paying for GI cases like these in Florida?

 

[annon123]

I can't answer your question as I am fairly new as an agent and am still learning, but if this answer is yes this seems like a useful loophole (eg enroll in one that will end) if/when available.

As an aside, since you just dealt with UHC with someone with a cardiac issue, do you know how UHC defines cardiac blockage (eg needs treatment or just has plaque in there so has some blockage but with no symptoms - and if they have been two years since the diagnosis with still no treatment can they answer no?) and kidney disease (stage 3a but stable at that for 14 years and no meds for that so they can answer no to that too?)? This person already has UHC G+, isn't using the "free" benefits (as not much around here accepts them), and wants to switch to the no extras UHC G because it is much cheaper here.

 

[ValeRosso]

Yes, if the plan terminates they'll get a GI if they return to OM.

 

[Chazm]

If they can get the Cigna plan. Aetna has a terming PPO in central FL. I have a Nov T65 that wanted to sign up for it but it wasn’t available anymore. I had to pick a different PPO and then move him again.

 

[Special Agent]

If they can get the Cigna plan. Aetna has a terming PPO in central FL. I have a Nov T65 that wanted to sign up for it but it wasn’t available anymore. I had to pick a different PPO and then move him again.

It seems like it can be done on medicare.gov.Any idea if they submitted application today for 12/1 how long it would take to get termination letter from cigna ?

 

[axeman462]

It seems like it can be done on medicare.gov.Any idea if they submitted application today for 12/1 how long it would take to get termination letter from cigna ?

If it goes through, probably around mid December.

But it is entirely possible, and likely the application gets denied.

 

[Special Agent]

If it goes through, probably around mid December.

But it is entirely possible, and likely the application gets denied.

i thought if a person lives in the service area,has a and b and has an eligible enrollment period they can enroll in an available plan .do you have first or second hand knowledge of someone being denied enrollment.Seems like that would be something CMS would be against.

 

[axeman462]

i thought if a person lives in the service area,has a and b and has an eligible enrollment period they can enroll in an available plan .do you have first or second hand knowledge of someone being denied enrollment.Seems like that would be something CMS would be against.

I vaguely remember being told at a rollout years ago that CMS usually closes off enrollment to a plan if its being terminated, if it's not being cross-walked to another plan.

I also know an agent that tried something like this years ago, and the application got denied.

Although this was like 12 years ago, and before they started handing out SEPs and GIs like candy. It feels like today we are in the wild west of enrollments. I would recommend just giving it a try. Worst thing could happen is you lose a little bit of time

and yes, UHC pays full commish for GI in Fla