Guy has BOTH MediGap and MAPD

[AugustaMi]

Haven't come across this yet. ***1st year Newbie situation alert***

Out today DKing (no complaining, I had a direct.mailer--)/ guy was happy to have me come in and talk to him. Not LIS, not medicaid, not even close to low income.

Guy tells me he has BOTH Medico Plan N, $175 month and HAP $0. I asked him if I could see his cards, sure enough. HMO MAPD ($4500 Moop) and Plan N.

I asked him who helped him with his coverages, he proudly tells me he did both himself- med supp awhile ago when he was turning 65, and for MAPD went to medicare.gov, then called HAP himself to enroll.-- bc he had no PDP he was looking for a less expensive way for his $500 90 day Xarelto script. Said he's had MAPD since Jan. he's 75. never had PDP so LEP $38ish.

He was in past year diagnosed with prostate cancer and has already had the main treatment minus a few other things left to do, not sure what the treatment was, no chemo. Said doctor billed MAPD and no problems or scary bills yet. Prognosis he says is good.

whats up here? Could he just be using med supp at doc and MAPD rx at pharmacy? Don't billing depts say hey somethings up here? or isn't this flagged somehow?

When they screw up (if it was actually a screw up) and have BOTH what to do? he said he's keeping both just in case". He thought the Med supp could supplement his MAPD. I said, "no, not supposed to have both...yada..." He said he's calling to cancel his Med Supp. I went deeper on that idea for him in the leaning toward not ... I went over Supp vs MAPD, Medicare 101. touched on trial period. I left it with a "there's your info, up to you, I'll check in with ya in the future..."

maybe he's trying to play the system in a way I haven't seen yet? getting himself some dental Rx etc all in one plan and trying to keep his gap going? Which is one reason I'm posting this. How common is this?

What would a seasoned medicare vet do on this? I did lean him into rethinking the cancelling his Supp and how to disenroll if he wanted from MAPD.

ugh, part of the job I guess, pro bono ( oh hell no no). Just kidding.

Side note: And really?! CMS wants agents to refer people directly to medicare.gov in that new disclaimer, you know, bc agents don't offer all carriers. So they can just do this themselves. haha.

 

[LostDollar]

Guy tells me he has BOTH Medico Plan N, $175 month and HAP $0. I asked him if I could see his cards, sure enough. HMO MAPD ($4500 Moop) and Plan N.

I asked him who helped him with his coverages, he proudly tells me he did both himself- med supp awhile ago when he was turning 65, and for MAPD went to medicare.gov, then called HAP himself to enroll.-- bc he had no PDP he was looking for a less expensive way for his $500 90 day Xarelto script. Said he's had MAPD since Jan. he's 75. never had PDP so LEP $38ish.

Caveat, not an agent.

I think it is ok that he has both plans, as long as he does not try to use the Plan N while he has the MAPD. If he uses the Plan N while he has the MAPD, then there is a problem, but I don't know if there are "systems" that would catch that.

I went through this discussion here 3-4 years back while trying to decide if I could have a Medigap plan and an MSA plan simultaneously.

(The thing to note here is that the person has already had the Medigap plan for some time, he is not buying both at the same time.)

 

[AugustaMi]

Caveat, not an agent.

I think it is ok that he has both plans, as long as he does not try to use the Plan N while he has the MAPD. If he uses the Plan N while he has the MAPD, then there is a problem, but I don't know if there are "systems" that would catch that.

I went through this discussion here 3-4 years back while trying to decide if I could have a Medigap plan and an MSA plan simultaneously.

(The thing to note here is that the person has already had the Medigap plan for some time, he is not buying both at the same time.)

I believe you are correct. I will say though, I think he might have used his medigap based on our talk about his claims. He said mapd billed but didn't sound like it based on the way he answered a few questions about claims

I should have asked if he would mind sharing his EOCs. Next time. This can't be common.

 

[somarco]

When he enrolled in MAPD they (MAPD carrier) are SUPPOSED to notify Medicare . . . the MAPD replaces Medicare as primary coverage.

He is SUPPOSED to cancel the Medigap . . . but apparently did not.

Medigap carrier normally receives claims adjudicated and paid by Medicare. Very rare for them to get claims direct from the provider or policyholder.

Once he enrolled in MAPD, original Medicare is no longer involved. A check of his MyMedicare account SHOULD reflect MAPD coverage only. He is due a refund from the Medigap for premiums paid from January until now.

Michigan is not a GI state so once this is straightened out, he will not be able to replace the Medigap any time soon.

This is NOT common . . . I have only run into it a few times . . . either a DIY project or an unscrupulous agent was involved.

 

[LostDollar]

He is SUPPOSED to cancel the Medigap . . . but apparently did not.

(caveat, not an agent)

I disagree here. The distinction is between owning both and using both. I think a person can own both as long as they don't use both.

The government language for this situation is something like "you may want to drop", not "you must drop", your medigap plan.

Medigap policies can't work with Medicare Advantage Plans. If you have a Medigap policy and join a Medicare Advantage Plan (Part C), you may want to drop your Medigap policy. Your Medigap policy can't be used to pay your Medicare Advantage Plan copayments, deductibles, and premiums.

Medigap & Medicare Advantage Plans | Medicare

Medigap carrier normally receives claims adjudicated and paid by Medicare. Very rare for them to get claims direct from the provider or policyholder.

At least for claims in 2022, I am finding this works differently for Part B claims submitted by hospitals to the KS Medicare MAC. The Medicare MSN does not show automatic sending of the hospital claim to the Medigap carrier.

I can see this playing out in the claims world because the hospital is causing their billings to go to an old, non-current, Medigap provider. When I got the hospital to re-submit one of the claims to the correct Medigap plan, it was denied by the current Medigap plan. Speaking to a representative of the current Medigap plan, I learned that the claim was denied because the hospital had not sent them a copy of the EOMB. The rep said as soon as the hospital sent the EOMB, they would process the claim.

 

[LostDollar]

Said he's had MAPD since Jan. he's 75. never had PDP so LEP $38ish.

Michigan is not a GI state so once this is straightened out, he will not be able to replace the Medigap any time soon.

(Caveat, not an agent)

If he just bought the MAPD this Jan couldn't he also consider dropping the MAPD as an option?

 

[TwoCents]

When he enrolled in MAPD they (MAPD carrier) are SUPPOSED to notify Medicare . . . the MAPD replaces Medicare as primary coverage.

He is SUPPOSED to cancel the Medigap . . . but apparently did not.

Medigap carrier normally receives claims adjudicated and paid by Medicare. Very rare for them to get claims direct from the provider or policyholder.

Once he enrolled in MAPD, original Medicare is no longer involved. A check of his MyMedicare account SHOULD reflect MAPD coverage only. He is due a refund from the Medigap for premiums paid from January until now.

Michigan is not a GI state so once this is straightened out, he will not be able to replace the Medigap any time soon.

This is NOT common . . . I have only run into it a few times . . . either a DIY project or an unscrupulous agent was involved.

This is exactly right -- claims are supposed to pass from Medicare to the Medigap carrier so with the MAPD in effect, Medicare (and the Medigap) shouldn't get any claims to pay on. I would just lean more towards cancelling the MAPD when possible.

 

[XpressInsurance]

I have come across several people over the years that had both. The MAPD pays and Med Supp collects premiums without paying out claims. A week or so after last AEP I ran across a guy in New Hampshire who got a Bankers plan N while he was still working, then signed up for a Wellcare PPO because he like the football player in the commercial. He had all 3 for 2 years.

 

[LostDollar]

I have come across several people over the years that had both. The MAPD pays and Med Supp collects premiums without paying out claims. A week or so after last AEP I ran across a guy in New Hampshire who got a Bankers plan N while he was still working, then signed up for a Wellcare PPO because he like the football player in the commercial. He had all 3 for 2 years.

Was his final choice Medigap World or MA World? (Just being curious.)

 

[Midlevel]

Once he signs up for MAPD the part b premium is now being sent to the MAPD carrier so Medicare is not going to pay on any of the claims sent to them. Can't really use the 12 month trial period in this case I wouldn't think because technically he never dropped a Med Sup to enroll in an MA plan. To me he is just throwing away the Plan N premium he has been paying. Like Somarco said if Medico hasn't paid any claims he should be able to prove to them he has had MAPD since 1/1/22 and get refunded his premiums.