Having Both MAPD and Med Sup

[myinsurebiz]

Bahahahaha

There's that damned sheep sound again. Why are you laughing Lamb Chops?

Because a non-licensed consumer hasn't a clue.

Peeps have ZERO need for a med supp and Part C at the same time. An Agent would never allow this to happen for their client.

Wonder what *ick thinks?

 

[goillini52]

Yes. I have persisted in my comments in this thread only because it seemed to me that op was going to miss an opportunity for the best way to help his client. I have repeated myself several times and am going to be done posting in this thread.

What everyone is saying is that as an agent, we can't knowingly participate in you having both a Med Supp and MA. Yes, you can do it on your own and I believe Craig told you that and I did too in PM.

Bottom line is that YOU might be willing to do this. You'd be hanging on to HDF, even though you wouldn't be using it. You'd be hanging on to the HDF, so you wouldn't have to be underwritten later on in case you didn't want to keep the MA. I don't think it would be as easy to do this with a Plan F or G because of the extra premium.

Makes sense to me.

 

[goillini52]

Because a non-licensed consumer hasn't a clue.

Peeps have ZERO need for a med supp and Part C at the same time. An Agent would never allow this to happen for their client.

Wonder what *ick thinks?

But what he's saying is true. If he wants to carry both, he can. In his situation, it might make sense because he's got a HDF. He'd be paying about $500 a year to guarantee that he'll be able to have the HDF if he decides down the road that he doesn't like the MA. If his health goes downhill, he doesn't have to worry about qualifying...because he'll already have it.

*ick....now there's a name from the past.

 

[LostDollar]

Whoa up guys. I said I wasn't going to make another post here, but I need to make one more.

This thread is NOT about whether or not I will or will not prospectively purchase an MAPD in addition to a Medigap policy.

It is about an agent who has a client, who due either to agent error or agent deception (by a different agent) Is currently in the situation of having both a Medigap plan and an MAPD. The agent (op) appears to be considering writing a PDP to cancel the MAPD and then also getting the client's current Medigap plan (with a favorable T65 rate) cancelled and writing a new one at some less favorable rate (because of age and health issues).

What I have been trying to say, again and again and again, is that BECAUSE of research I had done in regard to having both an MA (MSA plan) and a Medigap plan, I know that a medicare beneficiary, if they already have a Medigap plan can subsequently acquire an MAPD and keep the medigap plan in force by paying its premiums--which is exactly the situation op's client is in. I have been saying that all op needs to do is write the PDP and then run any necessary interference with the Medigap carrier to see that current plan stays in force. All op gets at this time is a PDP commission, but it seems to me that that also sets up a powerful reference source from helping a client out of a situation she may not fully understand how she got into. There is no sneaking or hiding necessary as the original post seems to suggest, because the situation does not violate any CMS rules.

That's the best I can say it.

 

[Stephen]

What everyone is saying is that as an agent, we can't knowingly participate in you having both a Med Supp and MA. Yes, you can do it on your own and I believe Craig told you that and I did too in PM.

Bottom line is that YOU might be willing to do this. You'd be hanging on to HDF, even though you wouldn't be using it. You'd be hanging on to the HDF, so you wouldn't have to be underwritten later on in case you didn't want to keep the MA. I don't think it would be as easy to do this with a Plan F or G because of the extra premium.

Makes sense to me.

He also said that if you get caught using all 3 polices at the same time that CMS would come and reclaim back payments for doing so. Anyone that does this for a living knows that that isn't possible .

 

[sshafran]

(Caveat, not an agent)

I looked into having a supplement and an MAPD at the same time when I was looking at an MSA plan. As I understand it, a beneficiary who already has a medigap plan can purchase an MAPD plan and continue to pay the premiums on the medigap plan. You just aren't allowed to use them both in the same year.

For clarity - they just won't co-ordinate when both are in-force at the same time. It's not that they aren't allowed to use them in the same calendar year - as there are opportunities to switch from MAPD to original medicare + gap in the same year. One of the two has to be primary at any given moment.

MAPD will become primary and the bills will never be sent to the Medigap plan for secondary payment.

On the surface, if someone has both a medigap and an MAPD and they use the medigap for hospital and /or doctor services this is impossible - you can't use the medigap for hospital and /or doctor services when MAPD is primary, as the provider does not bill medigap directly, and medigap doesn't approve/decline independently - they approve/decline, based on original medicare's approved/declined claims. and the MAPD for the drug and vision benefits, it seems like they would be leaving themselves open for CMS to reclaim all payments made for the beneficiary by both CMS and the Medigap carrier. It wouldn't happen as the bill would be sent to MAPD as primary. I don't know what the actual legal details would be.

Red is where you strayed. Blue is the explanation about how it was incorrectly understood.

 

[goillini52]

He also said that if you get caught using all 3 polices at the same time that CMS would come and reclaim back payments for doing so. Anyone that does this for a living knows that that isn't possible .

I must have missed that part, because when you go MA, the original Medicare is turned off, so you can't use all 3 at once.

 

[sshafran]

His supplement caught up after about four months and was going to cancel.

As long as I pay my Medigap premiums too, I can own both the Medigap and MAPD plans and the Medigap carrier may not cancel my coverage just because I also own an MAPD or MA plan.

Based on my client's experience the med supp insurer can cancel you.

Here is a third party sales organization article on the subject:

Medicare Advantage & Medicare Supplement Plan Coverage

Ok, this is actually kinda interesting.

So, I did a search in the .pdf of the guide to choosing a Medigap policy. I assumed it would say, they can't cancel you as long as you pay your premium. I swear, I've read that 100 times.

But, it doesn't say that. I says, "Any standardized Medigap policy is guaranteed renewable even if you have health problems. This means the insurance company can’t cancel your Medigap policy as long as you stay enrolled and pay the premium."

Pg 13 of the 2017 guide.

That statement, "stayed enrolled" is interesting. Stay enrolled... in what? Original Medicare? i.e., don't enroll in something else as primary - e.g., MAPD?

With enrollment in B as primary being a requirement to get it... seems like keeping B as primary could be argued as the very thing needed to "stay enrolled in" to stay enrolled.

So, ehealth - which LD referenced, seems to think "no problem." But, like many of us, they may assume, just pay premium, carrier must keep you. You have to remember, ehealth has about as much credibility as any other insurance agency... they're subject to mistakes.

But - what, exactly, does "stay enrolled" mean? Surely, it's not stay enrolled in the supplement, as that is determined by paying premium. It's something separate.

Seems to me to be a good catalyst for a carrier to make an argument that they can drop you if you pick up a MAPD.

Obviously, one carrier thinks they can cancel the medigap if A&B are no longer primary...

We're going to the Supreme Court with this one!!

 

[Hopes]

sshafran, thanks for shedding light on the dilemma and opening up the door of understanding. You guys (agents) know I don't have your experience, as much as I read about it so I often cannot argue my point.

My client (then a prospect) called to see if I could get him extra benefits. When I went to see him, I discovered he had been enrolled in an mapd (without his understanding of the consequences). I disenrolled him and put him back on a pdp.

He called me in April and said he received a letter saying his supplement was cancelling. I went over and read the letter. We called MOO, explained the situation and was told we needed to submit confirmation that the mapd had been cancelled. It took roughly 10 days to receive. I went back and helped him forward it.

That's the only experience I have with it. I thought that was how all insurers would handle a similar situation.

 

[HealthGuy]

We seem to be going in circles here....SO, can a person have a traditional supplement and an MAPD in force at the same time ?!?! What if they have a supplement and Medicare D drug plan..What happens THEN IF they enroll in a MAPD under that circumstance? Is the supplement along with the PDP automatically canceled if they enroll in a MAPD??