ESRD and med supp

[Winter_123]

Sorry to have two med supp issues back to back today but I just spoke with a prospect who has end stage renal disease.

I know that ESRD is the only medical knockout for medicare advantage but is that a knockout for med supp as well?
I dont see it anywhere but it does sound like a heavy hit for a carrier to have to take on. (poor babies).

He is still in open enrollment.

Winter

 

[GreenSky]

Enroll him. If he's just turning 65, there are no health questions.

Rick

 

[Frank Stastny]

Enroll him. If he's just turning 65, there are no health questions.

Rick

Yea, what Rick said.

Open Enrollment last for six months after the effective date of his Part B. You can enroll people in the hospital during that time.

After that six month period is he screwed. Better drop everything and go sign him up NOW. Don't let him get away.

 

[Winter_123]

Yea, what Rick said.

Open Enrollment last for six months after the effective date of his Part B. You can enroll people in the hospital during that time.

After that six month period is he screwed. Better drop everything and go sign him up NOW. Don't let him get away.

Supah.

Some of the carriers I have dont have pre X clauses but just to continue to educate me here, if a carrier does have pre X they could apply the exclusions that during open enrollment yes?

Not planning on using one of those but just want to confirm my understanding here.

Yes to pre X in open enrollment?

I am thinkinng no but maybe that is a result of the law in my state rather than med supp regs.

Winter

 

[Frank Stastny]

Supah.

Some of the carriers I have dont have pre X clauses but just to continue to educate me here, if a carrier does have pre X they could apply the exclusions that during open enrollment yes?

Not planning on using one of those but just want to confirm my understanding here.

Yes to pre X in open enrollment?

I am thinkinng no but maybe that is a result of the law in my state rather than med supp regs.

Winter

If the person has had credible coverage in the last 63 days the company cannot impose the pre-existing clause.

If your prospect has not had credible coverage in the last 63 days I would suggest you call and talk to an underwriter with the company just to be safe.

It is never a mistake to call and talk to an underwriter regardless of the situation. I do. I don't like surprises.

 

[retread]

If the person has had credible coverage in the last 63 days the company cannot impose the pre-existing clause.

If your prospect has not had credible coverage in the last 63 days I would suggest you call and talk to an underwriter with the company just to be safe.

It is never a mistake to call and talk to an underwriter regardless of the situation. I do. I don't like surprises.

A few points, most honorable Frank:

First of all, the term is “creditable” coverage, not credible. It refers to basic or major medical health insurance that covers such things as hospital, surgical, physician expenses, etc. These are benefits under catastrophic and/or comprehensive medical health policies. NON- creditable insurance is coverage for dental, vision, and often most individual supplemental policies with scheduled, limited, or defined benefits. All these policies are credible, but only some are creditable.

“Creditable Coverage

Includes prior coverage under another group health plan, an individual health insurance policy, COBRA, Medicaid, Medicare, CHAMPUS, the Indian Health Service, a state health benefits risk pool, FEHBP, the Peace Corps Act, or a public health plan “ – from Department of Labor



Secondly, the 63 continuous day requirement establishes the “creditable” coverage period.

If at any time during your prior “creditable coverage”, you let your policy lapse for more than 63 days, and should you then regain creditable coverage, none of the time covered prior to your 63+ days would be creditable towards a future exclusion period. That means that only the last unbroken (63 days or less) time counts to offset the exclusion period should the quid pro quo exception be granted.

Read your CMS publication on choosing a Medigap carefully. On pages 11 & 12 it says you may be subject to pre-ex (waiting)* period for Medigap coverage, but will still be covered under the Original Medicare Plan! IOW, Federal law for Medicare may “waive” pre-ex, but Medigaps do not unless you meet more rules: You must have had “creditable” insurance without a continuous 63 day break. It does NOT say the previous 63 days! However, logic demands that you must not allow 63 days to elapse from your loss of coverage until you pick up additional coverage or you will be subject to this penalty for the excessive delay. (As a matter of fact, some regs specify that the policy must be in force by the 63rd day! )

If you had “creditable” coverage w/o 63 continuous day lapse, then you can get credit towards the 6 month “waiting” period (poor choice of words here, but then, these guys are not known for their brilliance) quid pro quo. That means if your continuous creditable coverage was only for the last 63 days, then 63 days would be reduced from your exclusion period. To eliminate all exclusion of pre-ex, you must have had at least 6 months of prior "creditable" coverage, since the maximum pre-ex exclusion period for Medigaps is 6 months.

* The use of the term “waiting period” is misused here. It should say “exclusion period”. (A waiting period has to do with the time before ANY coverage commences, whereas an exclusion period means you have coverage EXCEPT for the defined exclusion and doesn’t begin until completion of the waiting period. There is no “waiting period” for Medigaps, but there is a pre-ex exclusion period.)