Leaving MA Service Area, IEP

[Bob L]

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.

WoW these med supp carriers seem to know much less about CMS regs than the MA plans. Talk to two different people and you get two different answers.

Glad you got it worked out. Enjoy your hard-earned commission.

 

[jacobtn]

What carrier was this??

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.