Guaranteed Issue Question

[Frank Stastny]

Something is not adding up in my little brain here. If someone is turning 65, and they have Medicare Parts A and B, wouldn't they have a GI period of 7 months for a MedSupp, and in some cases even longer regardless of the state since this is a Medicare (Federal) provision?
As far as MA plans, anybody with Parts A and B that can fog a mirror will get them, same as a PDP plan....there is no other qualifier.

It is not called "Guaranteed Issue". It is called "Open Enrollment" and everyone who has paid 40 quarters of Social Security is entitled to Medicare and Open Enrollment. There is a difference between Open Enrollment and Guaranteed Issue.

Actually an agent can date a Med Supp app, under "Open Enrollment", six months prior to the month they turn 65 and for six months after the effective date of Medicare Part B. For those who are over 65 and just receiving Medicare Part B they have an Open Enrollment period of six months following the Part B effective date.

 

[retread]

Something is not adding up in my little brain here. If someone is turning 65, and they have Medicare Parts A and B, wouldn't they have a GI period of 7 months for a MedSupp, and in some cases even longer regardless of the state since this is a Medicare (Federal) provision?
As far as MA plans, anybody with Parts A and B that can fog a mirror will get them, same as a PDP plan....there is no other qualifier.

The OP says the person is over 65. Pay close attention to what Frank says... he know of what he speaks. Agents who are very familiar with MA plans (myself included) get challenged with the differences between the use of closely sounding terms under MA and Medigap rules. For example: Open Enrollment under Medigap is NOT the same as Open Enrollment Period of MA. Also, the rules for PDPs are more restrictive than MAs. Another example: there is no such thing as an OEP for a PDP. Put that in your coffee and drink a sip.... The bottom line is: pay close attention to the precise meaning of the terms between MA and Medigap.

 

[MedSuppPro]

I have someone who is over 65 with both parts a and b. He is retired. His former employer is discontinuing his insurance. Does he qualify for guaranteed issue for a med supp?

Thank you in advance.

Can you tell us a little bit more about his insurance? For all we know this guy has a prescription drug plan only or a dental plan. I think we need more info. Look before you leap!

 

[rhcbp]

First off thanks to all for the replies. the guy lives in New Jersey, is retired and his old employer canceled his health insurance effective 12/31. He had medical, hospital and drug coverage through that plan. He has COPD and wants to get into a MAPD. My thought is that he should be in a med supp.

That does bring up another question: Let's say he gets into a MAPD and then within the first 12 months he wants to get into a med supp. would he have guaranteed issue then?

 

[jdeasy]

First off thanks to all for the replies. the guy lives in New Jersey, is retired and his old employer canceled his health insurance effective 12/31. He had medical, hospital and drug coverage through that plan. He has COPD and wants to get into a MAPD. My thought is that he should be in a med supp.

That does bring up another question: Let's say he gets into a MAPD and then within the first 12 months he wants to get into a med supp. would he have guaranteed issue then?

As long as the coverage was creditable, he can get an MAPD plan or stand alone PDP within 63 days of his coverage ending. You better move fast as he only has a few days left. He can get a stand alone MA plan until March 31 because of OEP.

He would also have a GI for a med sup for 63 days from the date coverage ended. Again, you better move fast if that's his choice of direction.


As for your question on the 12 month trial, yes, if it's his first time in an MA plan.

 

[retread]

As long as the coverage was creditable, he can get an MAPD plan or stand alone PDP within 63 days of his coverage ending. You better move fast as he only has a few days left. He can get a stand alone MA plan until March 31 because of OEP.

He would also have a GI for a med sup for 63 days from the date coverage ended. Again, you better move fast if that's his choice of direction.


As for your question on the 12 month trial, yes, if it's his first time in an MA plan.

Let me just add my two cents: I tell my clients (whether over OR under 65) to NEVER be caught 62 days without insurance.... because if their new creditable policy is not in place by the 63rd day they lose their Federal protections.

 

[moonlightandmargaritas]

because if their new creditable policy is not in place by the 63rd day they lose their Federal protections.

I believe it would be more accurate to say that their application has to be submitted before the 63rd day...

 

[jdeasy]

I believe it would be more accurate to say that their application has to be submitted before the 63rd day...

Yes. And he would have a couple of days to spare if he gets it in tomorrow.

 

[alphawave2k]

The OP says the person is over 65. Pay close attention to what Frank says... he know of what he speaks. Agents who are very familiar with MA plans (myself included) get challenged with the differences between the use of closely sounding terms under MA and Medigap rules. For example: Open Enrollment under Medigap is NOT the same as Open Enrollment Period of MA. Also, the rules for PDPs are more restrictive than MAs. Another example: there is no such thing as an OEP for a PDP. Put that in your coffee and drink a sip.... The bottom line is: pay close attention to the precise meaning of the terms between MA and Medigap.

I do listen to Frank, and that's the reason I responded back. After posting I realized the OP mentioned someone over 65.. I had thought about going back and reposting after realizing my answer addressed someone "aging in", but all the information got flushed through anyway. The only boo-boo in my response was saying GI vs. "open enrollment"....I said GI vs. "open enrollment" for Medigap which essentially means the same... wrong terminology for the purists....same "dag gan" result. But hey, I'll never confuse "open enrollment" for Medsups vs. AEP or OEP for MA's...OK??? Of course I didn't on my original post either.
All MA's are GI, and there other plans more appropriate for SNP's, QMBs. and SLMB's. Of course if all an agent cares to sell is the Medsup, then none of this matters. There are a lot of folks who desperately need help who happen to be in some of these conditional situations that might qualify them for some of these plans.
Let me say that I'd rather be a douche-bag (overwhelming opinion of Medsup pros on this forum) in trying to help someone who desperately needs that type of plan, instead of just saying to them, "Oh well, you can't afford a Medsup, sorry I cant' help you"
There is a lot of knowledge on this board, and sometimes even the most knowledgeable cut corners, and have posted wrong information. An honest mistake is OK, if you are man enough to swallow your pride and admit it.
Oh, regarding PDP's, I'll defer the next question to the more knowledgeable. I know there is a penalty for someone who doesn't sign up when they turn 65. I am not 100% sure if they still get hit with the penalty if they opt not to sign up and keep a group plan with creditable major med plan including Rx instead. It would seem to be a contradiction in having to carry 2 Rx plans, but I wouldn't put it past the geniuses at CMS to have some kind of screwy ruling on this. If someone knows the answer to this, please enlighten me.

 

[jdeasy]

I do listen to Frank, and that's the reason I responded back. After posting I realized the OP mentioned someone over 65.. I had thought about going back and reposting after realizing my answer addressed someone "aging in", but all the information got flushed through anyway. The only boo-boo in my response was saying GI vs. "open enrollment"....I said GI vs. "open enrollment" for Medigap which essentially means the same... wrong terminology for the purists....same "dag gan" result. But hey, I'll never confuse "open enrollment" for Medsups vs. AEP or OEP for MA's...OK??? Of course I didn't on my original post either.
All MA's are GI, and there other plans more appropriate for SNP's, QMBs. and SLMB's. Of course if all an agent cares to sell is the Medsup, then none of this matters. There are a lot of folks who desperately need help who happen to be in some of these conditional situations that might qualify them for some of these plans.
Let me say that I'd rather be a douche-bag (overwhelming opinion of Medsup pros on this forum) in trying to help someone who desperately needs that type of plan, instead of just saying to them, "Oh well, you can't afford a Medsup, sorry I cant' help you"
There is a lot of knowledge on this board, and sometimes even the most knowledgeable cut corners, and have posted wrong information. An honest mistake is OK, if you are man enough to swallow your pride and admit it.
Oh, regarding PDP's, I'll defer the next question to the more knowledgeable. I know there is a penalty for someone who doesn't sign up when they turn 65. I am not 100% sure if they still get hit with the penalty if they opt not to sign up and keep a group plan with creditable major med plan including Rx instead. It would seem to be a contradiction in having to carry 2 Rx plans, but I wouldn't put it past the geniuses at CMS to have some kind of screwy ruling on this. If someone knows the answer to this, please enlighten me.

If a person does not take part B when first elidgible because they have other creditable coverage, then they would not have a penalty if they pick up part B later. As long as they do it within 63 days of losing that creditable coverage.

The GI and open enrollment stuff does run together and sometime people refer to one when they mean the other.

I answered somebody about IEP recently because I didn't read the question fully that the person had already been on an MAPD plan. It happens.

Even a person that does only med sups needs to know about GI periods and even AEP, OEP and SEP situations if they need to help those med sup clients with a PDP.

I have maintained since I've been on this board that most problems with MA, MAPD and PDP's would go away if there was no lock in.