Learned Something New Recently

[G.Gordon]

A client last year got too busy with life and didn't pay his quarterly premium for part B. Lost it mid year. General enrollment to reactivate for 7/1/16. Done.

Now we decided to go with plan G with Transamerican verses the BF plan HdF he had, that at the time of application we found out that he never cancelled. So when we applied for TA I told the truth that he has an active medigap and also used the new part B date.

TA underwriter calls, the OEP for medigap is a one time, not to be repeated event. If a person has part B, turns it off due to returning to work place benefits, or loses it due to non-payment... regardless of reason... when he/she turns part B on again they technically do not have a new medigap OEP.

Now in reality, no insurance company is going to ask, "is this not the first time for part B", they just assume it is OEP and issue the plan. That is even what the TA underwriter said. The only way they caught this one was that I disclosed that the client has a medigap in force.

Interesting.

 

[WCMason]

A client last year got too busy with life and didn't pay his quarterly premium for part B. Lost it mid year. General enrollment to reactivate for 7/1/16. Done. Now we decided to go with plan G with Transamerican verses the BF plan HdF he had, that at the time of application we found out that he never cancelled. So when we applied for TA I told the truth that he has an active medigap and also used the new part B date. TA underwriter calls, the OEP for medigap is a one time, not to be repeated event. If a person has part B, turns it off due to returning to work place benefits, or loses it due to non-payment... regardless of reason... when he/she turns part B on again they technically do not have a new medigap OEP. Now in reality, no insurance company is going to ask, "is this not the first time for part B", they just assume it is OEP and issue the plan. That is even what the TA underwriter said. The only way they caught this one was that I disclosed that the client has a medigap in force. Interesting.

He lost his Part B due to non-payment but continued to pay for a med sup while he did not have Part B and as a result loses an opportunity to get another med sup without underwriting.

"Too busy with life" sounds like a very kind description of this guy.

 

[yogooglethis]

Re: Learned Something New.

He lost his Part B due to non-payment but continued to pay for a med sup while he did not have Part B and as a result loses an opportunity to get another med sup without underwriting.

"Too busy with life" sounds like a very kind description of this guy.

Too bad there is not a SEP- Non Mail Reader/Opener for this population.Would open up a lot of opportunity for agents!

 

[alphawave2k]

Re: Learned Something New.

Now we decided to go with plan G with Transamerican verses the BF plan HdF he had, that at the time of application we found out that he never cancelled. So when we applied for TA I told the truth that he has an active medigap and also used the new part B date.

Hmmm....makes you wonder, he was paying on his Med Supp w/o Part B active. Would the Med Supp have covered them? Also, what about the premiums collected while not "legally" entitled to have a policy under CMS rules?

TA underwriter calls, the OEP for medigap is a one time, not to be repeated event. If a person has part B, turns it off due to returning to work place benefits, or loses it due to non-payment... regardless of reason... when he/she turns part B on again they technically do not have a new medigap OEP.

This is good to know. Here is a nerdy situation that I honestly don't know the answer to: does this 1-time also mean once during the OEP and done? If within OEP, can someone switch out from company and/or policy, or not?

Now in reality, no insurance company is going to ask, "is this not the first time for part B", they just assume it is OEP and issue the plan. That is even what the TA underwriter said. The only way they caught this one was that I disclosed that the client has a medigap in force.

This raises at least one other question, such as what would have happened with this person who didn't qualify for OEP, yet was issued a policy? Particularly if he had a major medical event? The system is not infallible and riddled with loopholes that can hurt someone. I suppose that's why we have E&O, and more lawyers than we can throw a stick at!

 

[G.Gordon]

Re: Learned Something New.

I'm not sure and not concerned if the medigap would have covered anything at all. I guess if it would have paid it would pay as if Medicare was paying their part, but them again, medigap only pays AFTER Medicare pays.


During that first six month OEP a person can buy a different supplement every freaking day if they want.

He will be issued a plan, we reapplied with another carrier. This time, since he has already cancelled his previous medigap, we can honestly answer no and we also answered no to previous health insurance. All points are covered, there is nothing dishonest about it or misleading to the new company. They don't ask "is the person in their OEP or GI", it does ask "did you enroll in part B in the past six months", to which that is a YES answer and totally factual.

 

[alphawave2k]

Re: Learned Something New.

I'm not sure and not concerned if the medigap would have covered anything at all. I guess if it would have paid it would pay as if Medicare was paying their part, but them again, medigap only pays AFTER Medicare pays.

Just wondered what would have happened in a major medical event. We can probably say it would be a "case by case" basis. I've seen some gross incompetence that would put one of us on the hot seat, but seems to not impact those working for the companies.

During that first six month OEP a person can buy a different supplement every freaking day if they want.

Always wondered, and now I know, thank you.

He will be issued a plan, we reapplied with another carrier. This time, since he has already cancelled his previous medigap, we can honestly answer no and we also answered no to previous health insurance. All points are covered, there is nothing dishonest about it or misleading to the new company. They don't ask "is the person in their OEP or GI", it does ask "did you enroll in part B in the past six months", to which that is a YES answer and totally factual.

And that should be the question that matters. I believe most of us are not trying to do anything dishonest. Personally, I still fear CMS with its zany rules being enforced by hyper-vigilantes (reference here to the Advantage/PDP area).
I also wonder the questions almost every carrier asks about other products you might have sold this prospect in the past, or that might still be active. Not sure why that's any of their business, frankly. I could be missing something here, but that's been my thinking.

 

[AllyriaRedbird]

Re: Learned Something New.

"During that first six month OEP a person can buy a different supplement every freaking day if they want."

Yes, you did the right thing. Good job!

Now, tell me he is not quarterly pay?

 

[WCMason]

"During that first six month OEP a person can buy a different supplement every freaking day if they want." Yes, you did the right thing. Good job! Now, tell me he is not quarterly pay?

There is a Medicare rule that a med sup OEP is a one-time event. If Part B is dropped then re-enrolled in at a later date, there is no second OEP. Usually carriers do not know if a Part B effective date is a first- or second-time so there is no issue. In this case they know, so no OEP despite new Part B effective date.

Edit: just saw now that you wrote "first" six month OEP. Nevermind.

 

[G.Gordon]

Re: Learned Something New.

This client is wealthy and owns multiple businesses and a ranch. His loss of part B was pure oversight due to business and family health emergencies that "distracted" him. He realized the gravity of what he just did to himself and was very nervous for almost a whole year since he's been running around naked. That is probably why he kept the supplement... a security blanket.. even though it would not do much good.

 

[WCMason]

This client is wealthy and owns multiple businesses and a ranch. His loss of part B was pure oversight due to business and family health emergencies that "distracted" him. He realized the gravity of what he just did to himself and was very nervous for almost a whole year since he's been running around naked. That is probably why he kept the supplement... a security blanket.. even though it would not do much good.

I have a client who had a supplement but not Part B. I helped her write a letter to the carrier and she got 12 months refund totally around $1300. Then used her OE to get a sup when her GEP Part B began 7/1. Worth a try.