GI for MAPD increased costs: California only?

[The Medicare Gal]

Here's a question for you national writing brokers and gurus:

Here in California, if a client is with an MAPD plan and they have any increase in copays, premium, etc., they get GI with that carrier if the carrier is in the Medigap space as well.

f the carrier is NOT in the Medigap space (think Kaiser) then the increase has to be 15% or more, and they can get a GI with any Medigap plan in California.

I've been reading your posts, and it looks like a lot of you don't do GI because of the tiny or non-existent compensation, but I want to have the info for my clients when it comes up in non-CA states.

Does this 15% rule apply in any other states?

 

[TwoCents]

Here's a question for you national writing brokers and gurus:

Here in California, if a client is with an MAPD plan and they have any increase in copays, premium, etc., they get GI with that carrier if the carrier is in the Medigap space as well.

f the carrier is NOT in the Medigap space (think Kaiser) then the increase has to be 15% or more, and they can get a GI with any Medigap plan in California.

I've been reading your posts, and it looks like a lot of you don't do GI because of the tiny or non-existent compensation, but I want to have the info for my clients when it comes up in non-CA states.

Does this 15% rule apply in any other states?

Interesting. Also looks like for CA, if a provider leaves the MA network, a person gets GI, but of course if this happens mid-year, they may not be able to leave the MA.

 

[somarco]

CA is the only state I am aware of where it appears there is never any underwriting for anything.

 

[The Medicare Gal]

CA is the only state I am aware of where it appears there is never any underwriting for anything.

LOL....Occasionally we have to underwrite. But when it's underwritten then there's that nasty waiting period for pre-existing conditions.

 

[The Medicare Gal]

if a provider leaves the MA network, a person gets GI,

If a provider leaves the network, they have a SEP, but I'm not aware that they get GI during the SEP to go to a different MAPD. Interesting idea if it works. Where did you see this? I want to check it out.

 

[DS4]

Over the past 10 years, I've maybe submitted 5 underwritten apps in California. One was declined. No problem. Just waited until his birthday rolled around.

 

[DS4]

But when it's underwritten then there's that nasty waiting period for pre-existing conditions.

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[somarco]

Over the past 10 years, I've maybe submitted 5 underwritten apps

Slacker . . .

 

[The Medicare Gal]

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DS4 they can have a waiting period (for example with UHC it's three months) where pre-existing conditions are not covered, if it's underwritten. If it's GI or the "Birthday Rule", then there is no waiting period for pre-existing.

I guess this is a California thing also? Wow I'm learning so much in here!

 

[GreenSky]

DS4 they can have a waiting period (for example with UHC it's three months) where pre-existing conditions are not covered, if it's underwritten. If it's GI or the "Birthday Rule", then there is no waiting period for pre-existing.

I guess this is a California thing also? Wow I'm learning so much in here!

Nope. If they have current coverage there is no pre-ex.

Rick