Lost Part B, Got It Back in July. Do They Get Another OE for Supps?

[TN_agent]

Complicated situation, don't even know if I want to deal with it but I like learning the ins and outs of the rules and want to make the sale if I can do it legitimately.

Lady was disabled in 2004, presumably on A/B originally back then. She is 71 now.

She then went to jail at some point and lost her Medicare. Got out of jail in 2014. Had cancer in jail. Got part A back at some point after release, didn't get part B for whatever reason. Extra help. She enrolled during GEP this year and is back on Part B as of 7/1/2016

So, her Medicare card says part A date: 2/1/2004. Part B date 7/1/2016.

Does she get another open enrollment for medigap? How do I need to fill out the application? I don't know if she can pass underwriting with the cancer and her other issues that first caused her to be disabled. She wants an F. Maybe with UHC, would they consider this as within 3 years of her Part B start date (not in Open enrollment if that is the case)?

 

[vic120]

I did a case like this and got OE on med supp but had issues with drug coverage enrollment

 

[goillini52]

Complicated situation, don't even know if I want to deal with it but I like learning the ins and outs of the rules and want to make the sale if I can do it legitimately.

Lady was disabled in 2004, presumably on A/B originally back then. She is 71 now.

She then went to jail at some point and lost her Medicare. Got out of jail in 2014. Had cancer in jail. Got part A back at some point after release, didn't get part B for whatever reason. Extra help. She enrolled during GEP this year and is back on Part B as of 7/1/2016

So, her Medicare card says part A date: 2/1/2004. Part B date 7/1/2016.

Does she get another open enrollment for medigap? How do I need to fill out the application? I don't know if she can pass underwriting with the cancer and her other issues that first caused her to be disabled. She wants an F. Maybe with UHC, would they consider this as within 3 years of her Part B start date (not in Open enrollment if that is the case)?

The Med Supp company asks if she enrolled in Medicare Part B in the last 6 months. She's got a little over 3 weeks to go...better write it up quick!

 

[G.Gordon]

I did a case like this and got OE on med supp but had issues with drug coverage enrollment

That is because enrolling in part B is not a SEP for part D. It also is not a new OEP for medigap. Most companies will not ask and will never know and will issue 99% of the time as if it is OE. You get one OE for a supp. I've ran into this one time with TA where a member lost part B and refused to terminate his medigap that was with my office, he GEP'd beck into part B, when effective we applied for a new plan G with TA, indicated that he had an active plan hdF, TA asked about why he had an active medigap if his part B was not effective until July. I told them about losing part B, they denied the app unless the health questions were answered due to the fact that his OEP was already used.

We solved the problem by having him call the medigap and request a same day cancellation. We applied the day after the requested cancel date, therefore he didn't have an active meigap and the new company didn't ask any questions. No one lied to anyone and everyone is happy.

 

[TN_agent]

I did a case like this and got OE on med supp but had issues with drug coverage enrollment

She applied for extra help upon getting her Part A back and was automatically enrolled in coverage for PDP, so not an issue.

So, she is within 6 months of enrolling in B so technically in OEP? I want to do this right.

But am I also right in assuming that once approved she may have to wait for pre-existing to be covered because she has not had any other plan in place other than original medicare?

 

[jdeasy]

She applied for extra help upon getting her Part A back and was automatically enrolled in coverage for PDP, so not an issue.

So, she is within 6 months of enrolling in B so technically in OEP? I want to do this right.

But am I also right in assuming that once approved she may have to wait for pre-existing to be covered because she has not had any other plan in place other than original medicare?

What you are being told is that the company may not catch it. But they do not have another 6 month open enrollment. That's if they had part B before. If this is the first time in part B then they do have the 6 months.

You said "presumably" was on B before. That's a big question that needs to answered. Not presumed.

 

[G.Gordon]

Depending on the carrier for the pre-x thing. I'd steer clear of companies like TA and AARP that have a clear pre-x clause. MOO and others have no pre-x clause.

 

[somarco]

Medicare alone is creditable coverage.

 

[alphawave2k]

Her Medicare Part B effective date is what you see, and what you know as far as you know. Feigning ignorance, besides being bliss, can also help your cause here. We have all these effing crazy rules to hop scotch through, but you'd still be in compliance by writing her a med supp, and if you're active in PDP's, offer or guide her to "best" option since we're still in AEP.
I have never seen on any Med-Supp or MAPD apps questions asking to "provide Medicare history"...so, this is what you know today with tangible proof. The monkey is someone's back, and I don't think it's yours.
The only caveat is, if she's denied....she'll be SOL with straight Medicare + PDP come January/February, where she could at least have an MAPD (which for someone in her condition, might not be better choice now through AEP.)

So never point out a problem w/o a solution...some of the higher savants on these forums may advice if submitting both MAPD and Med Supp simultaneously is breaking these great rules we have to maneuver through. Yes, I know it's "illegal for anyone to sell you a Medigap Policy unless you're switching back to original Medicare"... p.84 Medicare & You 2017....but is it illegal to think through these dumb ass regulations to help your customer?

 

[LostDollar]

My

Complicated situation, don't even know if I want to deal with it but I like learning the ins and outs of the rules and want to make the sale if I can do it legitimately.

Lady was disabled in 2004, presumably on A/B originally back then. She is 71 now.

She then went to jail at some point and lost her Medicare. Got out of jail in 2014. Had cancer in jail. Got part A back at some point after release, didn't get part B for whatever reason. Extra help. She enrolled during GEP this year and is back on Part B as of 7/1/2016

So, her Medicare card says part A date: 2/1/2004. Part B date 7/1/2016.

Does she get another open enrollment for medigap? How do I need to fill out the application? I don't know if she can pass underwriting with the cancer and her other issues that first caused her to be disabled. She wants an F. Maybe with UHC, would they consider this as within 3 years of her Part B start date (not in Open enrollment if that is the case)?

According to the internal facts of your post, there is no "presumably" about Part A. She has had it since initial enrollment. If you asked her to create and access a MyMedicare account with you looking on, would that give any "in and out of Part B" information?