Guaranteed Issue Question

[Frank Stastny]

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.

I wasn't "busting your ass". I made the distinction between the two because those are the terms used by Medicare and the insurance companies. Although you are correct, either way the prospect gets to take a Med Supp without having to answer health questions.

An agent called me last month and was upset because he said he lost a sale. He said he called the insurance company and asked for information on their "guaranteed issue" Med Supps. They told him they didn't have any "guaranteed issue" Med Supps and that ended the conversation.

He really wanted information about selling a policy under "Open Enrollment" but used the term "guaranteed issue" instead. If he had used the correct terminology he would have gotten the information he needed and probably made the sale. By the time he found out the difference and contacted the prospect she had already taken a policy with another agent. It was with that in mind that I made the comment.

I have never, nor would I ever refer to someone who sells MA plans as a "douche-bag". The only Part C plan I can sell in rural Missouri is a PFFS plan. I don't sell them because I don't believe they are in my clients best interest. I personally believe that they would be better off just having Medicare Part A and B and the flexibility it provides. I explain in detail why I am suggesting that to them. That view is shared by many other agents in Missouri who also only sell in rural areas. If they still want a PFFS plan then I refer them to an agent who I know will take good care of them.

I don't prospect in low income areas so I rarely encounter people who are destitute. If I did, I may take a different approach.

 

[alphawave2k]

I wasn't "busting your ass". I made the distinction between the two because those are the terms used by Medicare and the insurance companies. Although you are correct, either way the prospect gets to take a Med Supp without having to answer health questions.

An agent called me last month and was upset because he said he lost a sale. He said he called the insurance company and asked for information on their "guaranteed issue" Med Supps. They told him they didn't have any "guaranteed issue" Med Supps and that ended the conversation.

He really wanted information about selling a policy under "Open Enrollment" but used the term "guaranteed issue" instead. If he had used the correct terminology he would have gotten the information he needed and probably made the sale. By the time he found out the difference and contacted the prospect she had already taken a policy with another agent. It was with that in mind that I made the comment.

I have never, nor would I ever refer to someone who sells MA plans as a "douche-bag". The only Part C plan I can sell in rural Missouri is a PFFS plan. I don't sell them because I don't believe they are in my clients best interest. I personally believe that they would be better off just having Medicare Part A and B and the flexibility it provides. I explain in detail why I am suggesting that to them. That view is shared by many other agents in Missouri who also only sell in rural areas. If they still want a PFFS plan then I refer them to an agent who I know will take good care of them.

I don't prospect in low income areas so I rarely encounter people who are destitute. If I did, I may take a different approach.

Good points, thanks for the explanation and the very well-received lesson. The check's in the mail. I don't prospect in the low income 'hoods either, however, every now and then someone pops up, even down the street from where I live that is in that sort of condition. ( I probably need to move soon).
But, I get a kick out of putting someone in a product that they had no idea existed, and it's going to be a great help for them. Not making a lot of money, but it makes me feel great.
You made a great point, and I wasn't thinking you were "busting my ass". I've had a few conversations with you, and I know your character, however, you have many zealous advocates on this board that are ready to take spear in hand at the least question of one of your posts. BTW, I'm one of them except I don't have any spears...I will resort to more modern weaponry. I wasn't BYA either with my comment about douche-bags, but there have been a few who feel that way. I always say, to each his own, and follow your convictions and your heart, but don't denigrate someone else just because they choose to delve into an area you feel is beneath you.
Humility is a powerful weapon in and of itself. Someday, I will master that virtue.

 

[retread]

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

I don't know about FL laws, but here in KS, your new creditable policy must be in effect by the 63rd day of prior lost coverage.

I say again... in effect by the 63rd day... at least in the state of Kansas. Just submitting an app before the 63rd day won't cut it. I has to be received and approved, and one day is not sufficient in almost every case.

 

[jdeasy]

I don't know about FL laws, but here in KS, your new creditable policy must be in effect by the 63rd day of prior lost coverage.

I say again... in effect by the 63rd day... at least in the state of Kansas. Just submitting an app before the 63rd day won't cut it. I has to be received and approved, and one day is not sufficient in almost every case.

That is a HUGE difference.

 

[Daytona_Guy]

There is no SEP, that is a term that applies to MA plans not Medicare Supplement plans, he will not be treated as though he is just turning 65, he will not have "Open Enrollment". It is important that agents giving advice on Medicare Supplement Plans understand Medicare's terminology.

Sorry, I get my terminology from Medicare as to the SEP:

Medicare.gov - Medicare Eligibility Tool (Eligibility Questions)
From Medicare.GOV:
Special Enrollment Period

If you are still receiving health benefits from your current employer or your working spouse's employer when you are eligible, you have the option of enrolling in Medicare Part B at a later date. You can sign up for Part B during the Special Enrollment Period. Most people who sign up for Medicare Part B during a Special Enrollment Period don't pay higher premiums. If this applies to you, you can sign up for Medicare Part B:

• Any time you are still covered by an employer or union group health plan, through your (or your spouse's) current or active employment. If you enroll in Medicare Part B while covered by the group health plan or during the first full month after the coverage or employment ends (whichever is first), your Medicare Part B coverage starts on the first day of the month you enroll. You also can delay the start date for Medicare Part B coverage until the first day of any of the following 3 months; or
• During the eight months following the month that the employer or union group health plan coverage ends, or when the employment ends (whichever is first). If you enroll during any of the 7 remaining months of the Special Enrollment Period, your Medicare Part B coverage begins the month after you enroll.

Note: If you are still working and plan to keep your employer's group health coverage, you should talk to your benefits administrator to help you decide when is the best time to enroll in Medicare Part B.
Note: When you sign up for Medicare Part B, you automatically begin your Medigap open enrollment period. Once your Medigap open enrollment period begins, it can't be changed or restarted.

 

[Todd King]

Originally Posted by Frank Stastny

There is no SEP, that is a term that applies to MA plans not Medicare Supplement plans, he will not be treated as though he is just turning 65, he will not have "Open Enrollment". It is important that agents giving advice on Medicare Supplement Plans understand Medicare's terminology.
​

Sorry, I get my terminology from Medicare as to the SEP:

Medicare.gov - Medicare Eligibility Tool (Eligibility Questions)
From Medicare.GOV:
Special Enrollment Period



What you have gotten from Medicare.gov is talking about the SEP concerning enrollment into Part B; Not individual supplemental insurance.

 

[Frank Stastny]

Sorry, I get my terminology from Medicare as to the SEP:

Medicare.gov - Medicare Eligibility Tool (Eligibility Questions)
From Medicare.GOV:
Special Enrollment Period

If you are still receiving health benefits from your current employer or your working spouse's employer when you are eligible, you have the option of enrolling in Medicare Part B at a later date. You can sign up for Part B during the Special Enrollment Period. Most people who sign up for Medicare Part B during a Special Enrollment Period don't pay higher premiums. If this applies to you, you can sign up for Medicare Part B:

• Any time you are still covered by an employer or union group health plan, through your (or your spouse's) current or active employment. If you enroll in Medicare Part B while covered by the group health plan or during the first full month after the coverage or employment ends (whichever is first), your Medicare Part B coverage starts on the first day of the month you enroll. You also can delay the start date for Medicare Part B coverage until the first day of any of the following 3 months; or
• During the eight months following the month that the employer or union group health plan coverage ends, or when the employment ends (whichever is first). If you enroll during any of the 7 remaining months of the Special Enrollment Period, your Medicare Part B coverage begins the month after you enroll.

Note: If you are still working and plan to keep your employer's group health coverage, you should talk to your benefits administrator to help you decide when is the best time to enroll in Medicare Part B.
Note: When you sign up for Medicare Part B, you automatically begin your Medigap open enrollment period. Once your Medigap open enrollment period begins, it can't be changed or restarted.

The information you stated above is correct, however, that is not the situation you were addressing in an earlier post in this thread.

The Special Enrollment Period applies only to taking Medicare Part B. Not a Medicare Supplement Plan. Even new agents know that. Not earth shaking news. Your statement did not address whether or not the employee had or didn't have Part B.

You stated above, It doesn't matter if he's being dropped or if he's electing to drop it himself at any time - both instances create a SEP = G.I. (See, no mention about Part B.) That is not 100% correct, it depends on the state. Something you should know since you are selling Med Supps "all over the country". I suggest you do some research on the individual states rules and regs as they pertain to whether or not it makes a difference if the employer drops the employee or if the employee opts to leave the group if they already have Part B.

If the prospect had not taken Part B when they turned 65 and delay it they will have a SEP to take Part B at a later date, there is no Special Enrollment period to take a Medicare Supplement Plan. This DOES NOT give them GI to take a Med Supp. The correct terminology used by Medicare is "Open Enrollment". There is a difference between Open Enrollment and Guaranteed Issue. Those are the terms used by Medicare and Insurance Companies. It would serve you well to know the difference between them.

Once they have opted to take Medicare Part B then they will have six months of Open Enrollment to secure a Med Supp without having to answer any health questions. That does not constitute, nor is it called "Guaranteed Issue".

If they already have Part B and the six month Open Enrollment period has expired and they voluntarily leave the group then they may have to answer health questions on the application. If they can't successfully answer "no" to the appropriate questions then they may not be able to get a Med Supp.

There is a lot more to selling Med Supps and doing it correctly to protect one's prospects than just telling everyone to take Plan F.

 

[Lyn]

Thats whats known as having a fish jump in the boat er I mean anytime a person loses their group coverage for any reason they are eligible for guarantee issue. Now set up him up with a name brand company(not gerber or mickey mouse life!)and if your lucky he may cause a couple of more fish to jump in your boat someday!

What name brand company(s) would you suggest?

 

[Yoda]

Mutual Of Omaha

 

[Todd King]

Yoda, if you knew what you were talking about you would never suggest Mutual of Omaha for med supps in Arkansas!

It's United of Omaha there.

The other thing that shows your ignorance is you referring to Gerber as a "mickey mouse" company. Do you not understand that Gerber is reinsured by Mutual and the comps are better?

Keep trying though; One day you might get something right!