How to Advise Client, IFP and Medicare?

[fleur]

A referral called me in February of this year. He stated that he turned 65 last year June, elected Medicare part A only, no PDP because he chose to stay on an IFP PPO plan with his wife, doesn’t take any meds anyways and health as a horse.
Not an employer plan, but IFP plan, off-exchange.

I advised him that he needs to apply for Part B before end of March which would not be effective till 7/1/2016, explained Part B penalty, Part D penalty and that a PDP could not be elected until AEP.

I sold him Med Sup G, effective 7/1/2016 and told him that he needs to cancel his IFP plan.

The wife just called me stating that she took him to the emergency room in the middle of June. Tests and scans revealed brain cancer.

He had surgery (different hospital) July 8th, is being transferred to SNF tomorrow which prompted her call to me because she was told they would probably owe around $14,000 for SNF because he is on Medicare.

At both hospitals, wife hands over his Medicare card and IFP PPO card.
She has no idea if or when husband cancelled IFP plan. Didn’t know about the Med Sup until today. Great communication going on in that household…….not!

Does anyone know what services would be paid by whom before July 1st?
Would the IFP plan pay at all since he turned 65 last year June?
What happens if he did not cancel IFP as of 6/30/16?

This is a first for me, need your advise.
Thank’s!

 

[WCMason]

A referral called me in February of this year. He stated that he turned 65 last year June, elected Medicare part A only, no PDP because he chose to stay on an IFP PPO plan with his wife, doesn’t take any meds anyways and health as a horse. Not an employer plan, but IFP plan, off-exchange. I advised him that he needs to apply for Part B before end of March which would not be effective till 7/1/2016, explained Part B penalty, Part D penalty and that a PDP could not be elected until AEP. I sold him Med Sup G, effective 7/1/2016 and told him that he needs to cancel his IFP plan. The wife just called me stating that she took him to the emergency room in the middle of June. Tests and scans revealed brain cancer. He had surgery (different hospital) July 8th, is being transferred to SNF tomorrow which prompted her call to me because she was told they would probably owe around $14,000 for SNF because he is on Medicare. At both hospitals, wife hands over his Medicare card and IFP PPO card. She has no idea if or when husband cancelled IFP plan. Didn’t know about the Med Sup until today. Great communication going on in that household…….not! Does anyone know what services would be paid by whom before July 1st? Would the IFP plan pay at all since he turned 65 last year June? What happens if he did not cancel IFP as of 6/30/16? This is a first for me, need your advise. Thank’s!

Primary: Medicare
Secondary until 7/1: IFP
Secondary starting 7/1: Supplement

The IFP should cover the charges that Part A and B would have covered for claims for June after/if the IFP deductible and OOP are met and if he did not cancel it before 7/1; it is worthless to him as of 7/1 as its deductible is likely higher than the $166 Medicare and the supplement won't cover. This assumes, of course, that he took your advice to enroll in B by the 3/31 GEP deadline. You don't say here.

 

[fleur]

Primary: Medicare
Secondary until 7/1: IFP
Secondary starting 7/1: Supplement

The IFP should cover the charges that Part A and B would have covered for claims for June after/if the IFP deductible and OOP are met and if he did not cancel it before 7/1; it is worthless to him as of 7/1 as its deductible is likely higher than the $166 Medicare and the supplement won't cover. This assumes, of course, that he took your advice to enroll in B by the 3/31 GEP deadline. You don't say here.

Yes he did get Part B effective 7/1/16.

Seriously doubt they met OOP on IFP before June.
I was under the impression that a person could not choose to stay on IFP plan over Medicare once they turn 65 unless covered by employer or retiree plan.
The only thing I found on Medicare.gov:

Can I get a Marketplace plan instead of Medicare, or can I get a Marketplace plan in addition to Medicare?

Generally, no. It’s against the law for someone who knows you have Medicare to sell you a Marketplace plan, because that would duplicate your coverage.

 

[WCMason]

Yes he did get Part B effective 7/1/16. Seriously doubt they met OOP on IFP before June. I was under the impression that a person could not choose to stay on IFP plan over Medicare once they turn 65 unless covered by employer or retiree plan. The only thing I found on Medicare.gov: Can I get a Marketplace plan instead of Medicare, or can I get a Marketplace plan in addition to Medicare? Generally, no. It’s against the law for someone who knows you have Medicare to sell you a Marketplace plan, because that would duplicate your coverage.

ACA plans have OOP of $4000-6,850 in 2016. He had a big medical event and start of treatment for it in mid-June with only Part A in front of the IFP. I doubt he met the OOP in the last two weeks of June, too, but doubt it less seriously given the information given.

The Medicare.gov site language is "get a Marketplace plan" instead of or in addition to Medicare. But he already had it. A person who keeps a Marketplace IFP after becoming Medicare-eligible loses any subsidy but doesn't lose the IFP. It's not a smart move to keep it given the 100% subsidy for Part A, 75% subsidy of Part B (for most), and relatively inexpensive med sups and Part D plans. But it's not illegal to have it, just illegal for an agent to sell it once someone is Medicare-eligible.

You helped put him in a much better place as of 7/1 right when he most needs it, saving him thousands; it's my favorite part of what we do. I hope he and his wife realize that, appreciate it, and reward you by telling everyone they know that they should call you (outside the markets I work, of course). I also hope he dropped that IFP.