Just found out have colon cancer while in supplement open enrollment

[sshafran]

Which date controls the rules under which the Medigap policy is issued, the policy application date or the policy effective date?

If he applies for a policy in December 2018 which will be issued on Jan 1, 2019; will the policy be issued under open enrollment/initial enrollment rules or under underwritten policy rules?

Effective. Using his scenario, he can't apply on 12/31 via open enrollment for effective 2/1/19 (or even 1/1/19).

I say this with 95% certainty as Ive never run into this exact situation where someone wants to apply during open enroll but also wants to delay the effective date to after open enroll.

But without verifying, my gut says that the carrier would want to underwrite the 2/1/19 effective date app.

Its Sunday and this unicorn of a scenario will likely never occur, so I'll just leave it at that.

 

[sshafran]

First, if you have not already done so, I would suggest that you create mysocialsecurity and mymedicare accounts. Those will be useful to you for information purposes.

I don't think you will get away from coding issues in the Medicare environment. However, my experience with claims for the past year suggests two things in regard to dealing with them.

If you disagree with Medicare's payment or non-payment decisions, I think your attempts to change those decisions will involve dealing with the provider and/or Medicare. (And by the way-Medicare (but not social security) has a 24 hour phone service-so folks on the forum have said you can get through easily in the wee hours of the morning.)

I think the only time you would have to deal with the Medicare supplement carrier is if/when information does not flow properly from Medicare to the supplement carrier-and then you are just working to see that the Medigap carrier has the correct information from Medicare. (If the situation would get very sticky, I think there is a way to get Medicare involved in support of that process-just can't tell you how that would work.)

For most (but not all) of my claims over the past year, the flow of Provider billing to Medicare MSN to Medigap EOB to provider billing to me has worked very smoothly.

Unfortunately, even with Medicare, you will still be in the situation where you will have to deal with some medical bills or insurance issues, and then you drop back to the standard decision criterion: Is this worth my time to argue over or shall I just pay it and be done?.

Do you think, perhaps, that if you chose Plan G like most agents recommend that you might have a bit less stress in life? Maybe some more time to relax, play golf, and just pay attention to one line item in your medical bills - the yearly deductible?

Seems to me like the Hi-F is more stressful on you thant anticipated.

 

[Todd King]

All the clients I've had that moved from Illinois to other states, kept the lower Illinois rates when they moved. If in doubt, call the company and ask them. That's what I did.

Yeah I’ve never had a client drop a supp by moving out of state. You just give them your new address and they get a new rate. I haven’t had many move out of FL but when they do, their rate drops significantly

Now see, right here is an example of conflicts. However, both of these say they get the lower rate. Rick's client's had to keep paying the higher rates. Something just ain't right here!

I do remember a time where, if you moved you had to change and you went with whatever they had in the area and with those rates. Sometimes you win and sometimes you lose. When did this change?

 

[LostDollar]

Do you think, perhaps, that if you chose Plan G like most agents recommend that you might have a bit less stress in life? Maybe some more time to relax, play golf, and just pay attention to one line item in your medical bills - the yearly deductible?

Seems to me like the Hi-F is more stressful on you thant anticipated.

Plan F, Plan G, Plan N or Plan HDF would not have changed the situations to which I referred.

The Medigap plan letter does not change provider coding issues or provider operating recovery room lack of Medicare notification issues.

The Medigap plan letter does not deal with Medicare issuing two MSN's for one service, resulting in two EOB's from the Medigap plan for the same service.

When the Medicare representative told me that Medicare did not send revised claims to the Medigap carrier, he did not say that it was because of the Medigap plan letter, he just said they did not do it.

So, three plan independent, provider caused situations, all requiring slightly different actions to correct.

(and primarily because of DS4's cracks about how badly I would harass an agent, I am dealing with them myself rather than discussing them with my agent.)

 

[Chazm]

Now see, right here is an example of conflicts. However, both of these say they get the lower rate. Rick's client's had to keep paying the higher rates. Something just ain't right here!

I do remember a time where, if you moved you had to change and you went with whatever they had in the area and with those rates. Sometimes you win and sometimes you lose. When did this change?

No one in particular. I’ve just had several people move out of state over the years and I thought they told me their rates dropped when they updated their address.

 

[LostDollar]

Effective. Using his scenario, he can't apply on 12/31 via open enrollment for effective 2/1/19 (or even 1/1/19).

I say this with 95% certainty as Ive never run into this exact situation where someone wants to apply during open enroll but also wants to delay the effective date to after open enroll.

But without verifying, my gut says that the carrier would want to underwrite the 2/1/19 effective date app.

Its Sunday and this unicorn of a scenario will likely never occur, so I'll just leave it at that.

I asked the question because I figured op's question about whether the open enrollment ended 12/31 or 01/01 came specifically because he was considering whether or not he could get a policy effective Jan 1 under open enrollment rules.

Sorting out all the issues about how beneficial a Medigap policy would be, scheduling a cancer operation, planning a move, considering VA treatment in two states, considering civilian cancer treatment in two states and considering medigap rates in two states could all combine to lead to a more delayed open enrollment purchase of Medigap than many folks might do.

 

[LostDollar]

Nothing stated by agents, prior to your comments, was inaccurate or incomplete.

One area of incompleteness involves the "company shuffle" mentioned for Mutual of Omaha. Mutual may have a reputation as the worst offender in this area, but recent posts by multiple experienced agents indicate that other companies are starting to do this as well. So op may not avoid the problem by going to another company.

 

[goillini52]

Now see, right here is an example of conflicts. However, both of these say they get the lower rate. Rick's client's had to keep paying the higher rates. Something just ain't right here!

I do remember a time where, if you moved you had to change and you went with whatever they had in the area and with those rates. Sometimes you win and sometimes you lose. When did this change?

I don't know Todd. I've only checked with 3 companies when clients were moving out of state. Aetna, Oxford and LCBA all said that they would keep their Illinois rates, which were cheaper than the state they were moving to. I have a feeling that they're all like that. I'd definitely call the company and check before I told anybody that though.

 

[sshafran]

One area of incompleteness involves the "company shuffle" mentioned for Mutual of Omaha. Mutual may have a reputation as the worst offender in this area, but recent posts by multiple experienced agents indicate that other companies are starting to do this as well. So op may not avoid the problem by going to another company.

That's ridiculous.

You're saying that an agent can no longer help a consumer find a stable company which is not likely to "shuffle"?

That's asinine.

So if I tell someone that, I'm being "incomplete" and should be subjected to your correcting hand?

Wow, man. You're an interesting fellow.

Again, nothing that was said needed your correcting advice.

 

[LostDollar]

That's ridiculous.

You're saying that an agent can no longer help a consumer find a stable company which is not likely to "shuffle"?

That's asinine.

So if I tell someone that, I'm being "incomplete" and should be subjected to your correcting hand?

Wow, man. You're an interesting fellow.

Again, nothing that was said needed your correcting advice.

The weight of your peers' relatively current posts in forum threads suggests that an agent can help a consumer find a company family which is less likely to shuffle than Mutual of Omaha but it is less and less likely that an agent or consumer will be able to find a company family which will not shuffle at some point because they are all starting to do so.

A consumer who is led to believe that only Mutual of Omaha is a shuffling company family is being misled by incomplete information.