MA- Med supp switchback period

Jan 2, 2008

  1. Winter_123
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    Winter_123 Guru

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    If a client in an MA wants to exercise the right to go back to a med supp in the first year do they have to wait to annual enrollment period or can they do that anytime during the year? (assuming that you are past march 31)

    Thanks,

    Winter
     
  2. senior-advisor-indiana
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    senior-advisor-indiana Guru

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    Anytime within 1st twelve months.
     
  3. craig_ritter
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    craig_ritter Super Genius

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    Agreeing with S-A-I, but I would add,
    1. Must be the first time they joined an MA plan.
    2. If they joined the plan at ICEP (turning 65, mostly), they would be GI into any plan with any company. Otherwise, they would have to go back to their former coverage (unless they no longer sell it, then, I believe, they have GI into A, B, C or F).

    Craig
     
  4. GreenSky
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    GreenSky Guru

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    Craig:

    This is specific to age 65 plus only. According to Lincoln Heritage and Mutual of Omaha, if you are under 65 you are not eligible for a GI after your ICEP.

    Both carriers' GI forms do not state this and I went round in circles with them trying to move a client, 9 months into Medicare, from her MA taken on day one into a Med Supp.

    My contention was that they are bound to honor their forms. They told me they cannot put everything in writing and only had to honor the law.

    I got Health Net to write her (at $100 more per month) and will give LHL a present on her birthday on Jan 31 (can do this in California).

    Rick
     
  5. craig_ritter
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    craig_ritter Super Genius

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    My bad, I really thought the federal protection with respect to first time enrollees was a bit broader. I re-read the section from the Medicare pub (2008 Choosing a Medigap policy, link below) and it appears this applies to T-65 only (protection #4 on page 19, I believe). So, this would exclude those enrolling in Part B at age 66 plus and those enrolling under age 65 (as you correctly stated), except if broadened by state law.

    Also, assuming the prior coverage were not available, you would be GI into A, B, C, F (and K and L, fwiw)!

    Off topic, does CA state law extend open enrollment for Medigap to the under 65 crowd? Under 65 regs are so varied by state that I'm looking to compile a state by state list for my own reference. Perhaps I could get this from an underwriting dept and post.

    http://www.medicare.gov/Publications/Pubs/pdf/02110.pdf

    PS - Add a "Happy Birthday" for your client from me too!
     
  6. GreenSky
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    Under 65 in CA are guaranteed a med supp when they get Medicare. They get another OEP when they turn 65.

    Rick
     
  7. retread
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    There is a distinction between T-65s returning to OM (Original Medicare) during the trial period (first 12 months) and over 65s doing the same. The T-65s can get their former Med Sup back BY LAW. Over 65s can get the plan they once had IF AVAILABLE, otherwise any Med Sup plan A, B, C, F, etc.
     
    retread, Jan 3, 2008
    #7
  8. GreenSky
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    GreenSky Guru

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    Well, guess what?

    I just received a call from Lincoln Heritage telling me that I was right when I originally told them that in California the GI provision (MA plan when you 1st get medicare, out within 12 months) applies to under 65.

    They are now issuing a plan for my client.

    Don't you just love all the rule changes for each state?

    Rick
     
  9. Winter_123
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    Winter_123 Guru

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    I know I am asking this a second time and it has been answered but since I got a bogus answer from United Health's "agent support" /DSU I would appreciate comments to keep me grounded.

    Regardless of what UHC said, it is my understanding that if a person joins an MA they can drop it anytime in the next 12 calendar months and return to original medicare and/or a med supp if it applies and THEY DO NOT NEED TO WAIT FOR AN ENROLLMENT PERIOD. Is this correct? If not just set me straight.

    What if it is an mapd? Can they just eturn to original medicare but must join a standalone rx plan until the next enrollment period or they get to bail out of the rx plan at the same time.

    If they return to a med sup under the guaranteed return period, they get to go back to exactly where they were before meaning that pre-existing conditions do not apply. Yes/no?

    Sorry for the repeat question, but the frigging carriers are so confused and uninformed themselves that I lost a little ground in my understanding and need to get regrounded. They are supposed to help right? Not!

    Thanks again.

    Winter
     
  10. midwestbroker
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    midwestbroker Guru

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    If this was your first enrollment into a MA or MAPD plan, you can go back to your supplement within 12 months of the effective date underwriting free. This does not guarantee they will get the same rate from when they left, but they can get it back.

    With Part D, if it was a MAPD, they can use a SEP to re-enroll in a stand alone part D plan with in 63 days of leaving the MAPD.

    This is the info that I have got. So far, I have not had to mess with it.
     
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