ESRD MAPD Termination & Med Supp Question

Discussion in 'Senior Insurance Forum' started by wehotex, Dec 11, 2014.

  1. wehotex
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    If a mb is on an MAPD that leaves the service area, but is on ESRD, are they still able to be a guaranteed issue on a Med supp policy when the MAPD leaves?
     
  2. medicareguru
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    Sure, why wouldn't they be able to qualify for a Med supp guarantee issue? The ESRD question pertains to Medicare Advantage plans; not supplements. Unless I am reading the question incorrectly.
     
  3. GreenSky
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    Unless the beneficiary is under 65, at least in CA.

    Rick
     
  4. walleyeb1
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    Good resource:

    http://www.medicare.gov/Pubs/pdf/10128.pdf

    Also, if you have End-Stage Renal Disease (ESRD) and are enrolled in a Medicare Advantage Plan (like an HMO or PPO) that stops being offered in your area, you have a one-time right to join another Medicare Advantage Plan if one is available in your area.
     
  5. medicareguru
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    yeah, but who would want to be on an MAPD if they have ESRD?
     
  6. GreenSky
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    Someone that might not qualify for a med supp?

    An out of pocket limit of $3,400 isn't the worst thing in the world for zero premium.

    Rick
     
  7. medicareguru
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    I am assuming you are speaking about California?
     
  8. GreenSky
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    I am. But even a 6,350 limit is better than no limit with Medicare only. The "trick" is to get the MA before ESRD. Otherwise it's SOL.

    Of course, if the person can get a supplement that would be the best option.

    Rick
     
  9. FLM2
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    I had a California resident with ESRD who is turning 65 referred to me by a friend and while Anthem and UHC won't accept him for a Med Supplement there are other companies (Mutual of Omaha, Humana and a couple of others) who consider him to be within his Open Enrollment rights.

    I called each of the companies and confirmed this with Agent services before making a recommendation to the referral.

    I submitted the application to Mutual this afternoon with his ESRD noted in the 'Notes to Underwriting' section, I will follow up here once it is through Underwriting (either way).

    This is my first ESRD case so, while surprised, it was good to see that he has options-he has been on group benefits for many years and his employer was going to take him off the group when he turned 65 whether it was compliant or not.
     
  10. GreenSky
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    T65 has no medical questions so ESRD is not a problem. It's open enrollment. ESRD is only an exclusion in CA for under 65 just getting Medicare.

    Why was this even an issue?

    Rick
     
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