Guaranteed Issue Question

[Yoda]

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!

Alright, United of Omaha then! I understand that something smells awfully fishy about that GERBER did I say that yet?

 

[lisaann66]

Frank, I need help please!!!

I've researched the code, the Medicare and You guide and still can't get a clear answer. Here's my situation:

I have a 60 year old that entered Medicare for the first time (disability) on 6/1/09. On 9/1/09 she entered a MA with Antham. She wants out! I'm 99% sure she will qualify even with underwriting (her disability was a single level fusion 2.5 years ago).

My question is: Does she get an SEP "initial trial period" to go back to original Medicare and pick up a gap plan wiithin 12 months, the same as if she were 65 years old?

I called Medicare they said "yes" that it falls under the SEP. I don't see age being referenced anywhere in the code. I would think it would be "against public policy" if a carrier declined her a policy because age? Does she have a guarantee issue or right to buy a Medigap policy if she wants to leave the MA within 12 months even if she is under 65?

Am I totally confused? Please help Frank!

Thanks,

Lisa Ann Fuoco
California Agent

 

[lisaann66]

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.

I like Plan G myself!

 

[bourbonlegend]

That's digging pretty far back to bump a thread.

2 things stick out -

Jdeasy knows his stuff

yoda does not

 

[lisaann66]

I know...my real question is this:

60 year old qualifies in Medicare for the first time. Enters a MA plan and wants to leave before the 12th month. Can she leave and get into a MS? Is she GI?

I read the Statute and Codes and Medicare And You guide and Choosing a Medigap Policy 2010 Book. I can't find anything that speaks of age? Called Medicare and they say "Yes" as per SEP.

Can anyone comment? I want to get the app tomorrow.

Thanks for your input!

Lisa Ann Fuoco
Northern California Insurance Agent

 

[Longtimeagent]

I know...my real question is this:

60 year old qualifies in Medicare for the first time. Enters a MA plan and wants to leave before the 12th month. Can she leave and get into a MS? Is she GI?

I read the Statute and Codes and Medicare And You guide and Choosing a Medigap Policy 2010 Book. I can't find anything that speaks of age? Called Medicare and they say "Yes" as per SEP.

Can anyone comment? I want to get the app tomorrow.

Thanks for your input!

Lisa Ann Fuoco
Northern California Insurance Agent

As the SEP Trial states, she would be GI into a Med Supp, I don't know what your state is like with under 65 med supps. We only have plan B with like two carriers and its around $300/mth. The typical GI would apply to the previous plan she was on before if she dropped a med supp to go onto the MA, which she didn't. She will get a letter from her MA stating that she is being disenrolled and will have 63 days to make an election of her health and prescription coverage. Go get the app!

Go to page 4

http://www.tfahealth.com/uploads/Medicare SEP Charts.pdf

 

[arnguy]

That's digging pretty far back to bump a thread.

2 things stick out -

Jdeasy knows his stuff

yoda does not

Speaking of Yoda, he has been awfully quiet lately. What happened, was he banned? I sort of miss his acerbic input.

 

[GreenSky]

I know...my real question is this:

60 year old qualifies in Medicare for the first time. Enters a MA plan and wants to leave before the 12th month. Can she leave and get into a MS? Is she GI?

I read the Statute and Codes and Medicare And You guide and Choosing a Medigap Policy 2010 Book. I can't find anything that speaks of age? Called Medicare and they say "Yes" as per SEP.

Can anyone comment? I want to get the app tomorrow.

Thanks for your input!

Lisa Ann Fuoco
Northern California Insurance Agent

Lisa:

The answer is yes, your client can indeed go into a med supp but you're running out of time.

There is another answer but it has to wait until the end of the year.

Drop me an email with your phone number. Happy to discuss this with you.

Rick

 

[lisaann66]

Thanks to those that responded. Still trying to find the legal written authority that speaks of this? Let me know if you can provide this I am going to need it.

Rick, I emailed you.

Thanks much,

lisa

 

[GreenSky]

I believe I made a mistake in my first "yes." Apparently this provision used to apply to everyone because I used it in the past. Now it is for 65+.

I have another idea that may of help, not right now but in a few months. I left you a voicemail.

Rick