Leaving MA Service Area, IEP

[somarco]

New client moving to GA. Currently has MA plan. Part B effective 3/1/15.

Move to GA will happen mid September. Wants Medigap. Good health, can pass underwriting but don't want to go that route if we don't have to.

Any problem with submitting app now (6th month) for a 9/1 eff date with Medigap then voluntarily disenrolling from MA plan end of August?

Or should he submit app now, continue MA through Sept then have Medigap effective 10/1?

 

[JimmyUt]

New client moving to GA. Currently has MA plan. Part B effective 3/1/15.

Move to GA will happen mid September. Wants Medigap. Good health, can pass underwriting but don't want to go that route if we don't have to.

Any problem with submitting app now (6th month) for a 9/1 eff date with Medigap then voluntarily disenrolling from MA plan end of August?

Or should he submit app now, continue MA through Sept then have Medigap effective 10/1?

What is he doing about drugs? Enrolling in a PDP for Sept 1st will automatically disenroll him. Use the SEP for that. I think you can go either route you are describing depending on what the client wants.

 

[somarco]

We have discussed PDP. Only takes a couple of low dose generic HTN meds.

If he quits his MA the end of this month (which is technically before he leaves the service area) can he still pick up a PDP or is that only good when he is automatically disenrolled by the MA plan?

 

[yogooglethis]

What is he doing about drugs? Enrolling in a PDP for Sept 1st will automatically disenroll him. Use the SEP for that. I think you can go either route you are describing depending on what the client wants.

Technically effective date can't be before person is physically in new address...


Time frame of SEP-change in residence:

- Before Move
Begins month before
permanent move
Ends 2 months after the
move

-After Move
Begins month consumer
notified current plan of the
move
Ends 2 months after
notification of move


effective date of SEP-change in residence:

First day of the month up to 3
months after receipt of
election but not earlier than
the day of move.

 

[somarco]

He has already notified MA plan of move. Don't know when he notified them, but he did. Could have been in July, or August.

Expects to be in GA mid September.

Back to my other question. If he applies now can he have Medigap effective 10/1?

I am assuming he can. Have had clients before that applied at the end of their IEP and pushed out the eff date about 60 days. This one is different because he is currently in an MA plan. I wouldn't think that would matter but figured I would ask.

As I said, he can pass underwriting so GI is not needed. Just don't want to go through underwriting if he doesn't have to.

 

[Bob L]

He has already notified MA plan of move. Don't know when he notified them, but he did. Could have been in July, or August.

Expects to be in GA mid September.

Back to my other question. If he applies now can he have Medigap effective 10/1?

I am assuming he can. Have had clients before that applied at the end of their IEP and pushed out the eff date about 60 days. This one is different because he is currently in an MA plan. I wouldn't think that would matter but figured I would ask.

As I said, he can pass underwriting so GI is not needed. Just don't want to go through underwriting if he doesn't have to.

If you're sure he wants a supplement, you certainly can specify 10/1/15 as his effective date. You didn't mention if he was T65 in March, but if so, he would have a trial right if he got his MA when his Medicare started. He would have an SEP for a PDP too, of course. I don't think there is any scenario where you should try to have anything effective prior to 10/1 since, as yogoogle said, he cannot start a Part C or Part D plan in his new state prior to the date of his move, strictly speaking.

Seems to me the simplest path is to enroll him in his PDP effective 10/1/15 and send in the Med supp application to be effective the same date. Let them do the u/w or use his trial right GI, keeping in mind some carriers pay much less comp for GI -- could be a factor from your perspective!

 

[somarco]

He wants a supplement. Can he have the MA carrier terminate 8/31 and still get SEP? (Moving to GA around 9/10)

He is 68.

Never mind on the 9/1. See you addressed that.

He will not be GI. Either IEP or underwritten. Just wanting IEP to make it easier. That's why we will submit app this month.

 

[WCMason]

He wants a supplement. Can he have the MA carrier terminate 8/31 and still get SEP? (Moving to GA around 9/10) He is 68. Never mind on the 9/1. See you addressed that. He will not be GI. Either IEP or underwritten. Just wanting IEP to make it easier. That's why we will submit app this month.

If it were me I would write an Open Enrollment med sup with October 1 start date this month before OE ends for him.. Then get the client enrolled in a PDP using the relocation SEP for a 10/1 start.

This appears to be exactly what you had in mind in the first place--your second option--so happy to confirm you were on the right track all along.

 

[Ronnie Carter]

He wants a supplement. Can he have the MA carrier terminate 8/31 and still get SEP? (Moving to GA around 9/10)

He is 68.

Never mind on the 9/1. See you addressed that.

He will not be GI. Either IEP or underwritten. Just wanting IEP to make it easier. That's why we will submit app this month.

OK! Since he's 68, I'm assuming he got his Part A more than three years ago, so there is no IEP just for procuring Part B, and there is no trial right to avoid u/w on his Med supp, as that has expired long ago. His IEP for getting Part B would have ended 2/28/15 if his Part B started 3/1/15. However, he's in his last month of OE for his supplement.

As stated above, if you want to follow the rules, his effective date for his PDP would need to be 10/1/15 since he cannot have a plan in his new area prior to his move.

He can buy a supplement any time he wants through the year, but it needs to take effect when his current MAPD ends. Supplements don't play well together with MA's and there is no reason for him to make his new supp effective in September -- he would waste that first month's premium for no reason. He would need to use his moving-out-of-area SEP to enroll in his PDP effective 10/1/15, and you would specify 9/10/15 as the date of move on the app.

This should work seamlessly -- take the app now for his non-underwritten Med supp (open enrollment), as well as a PDP for him using the SEP, both effective 10/1/15. The enrollment in the PDP will automatically disenroll him from his current MA, so nothing to do there.

Piece of cake!

----------

Mr. Mason beat me to it -- gave his usual great advice in much fewer words!!

 

[somarco]

UPDATE:

Had to school the carrier on Medicare rules.

Client called to do his phone interview. They told him they could only offer a 9/1 eff date. If he wants 10/1 he will have to submit a new app on or after 9/1 and go through medical underwriting.

FWIW, he can pass, just trying to make it simple. Turned out to be not so much.

I called underwriting. Passed up to a senior underwriter, then dept manager.

Their story ........

Them - He has until August 31 to submit an application without medical history but only for a 9/1 eff date.

Me - Why not 10/1?

Them - That would be beyond his 6 month window.

Me - 9/1 is outside the 6 month window.

Them - We allow a 1 day grace period.

Me - Where does Medicare say you can have a grace period? Where does Medicare limit the effective date for coverage applied for during the window?

Them - This is the way we always do it. Where do you get your information?

Me - From Mcare.gov and pg 14, section 2 of the Choosing a Medigap Policy book. Let's read it together.

Them - Let me see if I can get you an exception.

Me - An exception to the Medicare rules?

Them - crickets ..........

A few minutes later they came back and said they would grant a one time exception, process his app as an open enrollment app and give him a 10/1 eff date.

Gee, how generous.