MACRA F vs G etc

[Cdevin]

So for years I have done business as A date before 2020 GI F, after G. I don't usually do GI business unless it is a paid state, or an existing client or a spouse of a client who can pass UW etc.

With that said this year I have been seeing some weirdness. States giving GI G when it should be F, for example Allstate in FL only offered the F through UW, but allowed GI G on two people whose A date was like 2014. Ok, one company and a one off.

Everyone has been sending me a copy of the letter advantage plans are sending them with all the advantage plans being discontinued showing plan N being GI. I always told them that isn't correct, and there is usually an asterisk by it. However a couple weeks ago I spoke to someone who told me Humana and Medico in GA was offering GI N for them. I didn't believe them, and I told them we couldn't assist unfortunately. I followed up because I thought his spouse could pass UW, and they emailed me back a copy of a plan N card...he couldn't pass UW under any circumstances. What am I missing? Has something changed with GI?

 

[goillini52]

So for years I have done business as A date before 2020 GI F, after G. I don't usually do GI business unless it is a paid state, or an existing client or a spouse of a client who can pass UW etc.

With that said this year I have been seeing some weirdness. States giving GI G when it should be F, for example Allstate in FL only offered the F through UW, but allowed GI G on two people whose A date was like 2014. Ok, one company and a one off.

Everyone has been sending me a copy of the letter advantage plans are sending them with all the advantage plans being discontinued showing plan N being GI. I always told them that isn't correct, and there is usually an asterisk by it. However a couple weeks ago I spoke to someone who told me Humana and Medico in GA was offering GI N for them. I didn't believe them, and I told them we couldn't assist unfortunately. I followed up because I thought his spouse could pass UW, and they emailed me back a copy of a plan N card...he couldn't pass UW under any circumstances. What am I missing? Has something changed with GI?

It might be state specific. The way it's supposed to work is if they're eligible for Medicare before 01/01/2020 and want to do GI, they have to go with Plan F. If eligible after 01/01/2020, they have to go with G.

Humana recently sent this.

Carly Maldonado
From:[email protected]

Fri, Nov 8 at 8:21 AM


Hello trusted partner,

I wanted to send a quick reminder about using the guaranteed issue (GI) right for a med supp when you have an MAPD plan exit. Please remember that Humana follows MACRA regulations. This means that anyone who had Medicare A and/or B before 2020 cannot use GI into a plan G or N. Anyone with Medicare A and/or B after 2020 can use the GI right to get a plan G. Plan N does not allow GI on a plan exit. Here is the federal rule, please call me with questions:

GUARANTEED ISSUE RIGHTS TRIGGERED BY A CIRCUMSTANCE AS REFLECTED IN THE CHOOSING A MEDIGAP POLICY PUBLICATION (STATE SPECIFIC GI RIGHTS MAY BE AVAILABLE)	AVAILABLE GUARANTEED PLANS AS REFLECTED IN THE CHOOSING A MEDIGAP POLICY PUBLICATION (SPECIFIC STATE REQUIREMENTS APPLY AND ADDITIONAL PLANS MAY BE REQUIRED)	WHEN TO APPLY WITH GUARANTEED ISSUE
	Please note: members in CA, ME, NJ, OK, OR and TN can apply for any plan* available in the state. *Plan C and F are no longer available to people new to Medicare after January 1, 2020.
Applicant's Medicare Advantage plan is leaving Medicare, stops giving care in member's area, or member moves out of plan's service area.	If eligible for Medicare prior to 1/1/2020: Medigap Plan A, B, C*, F*, K, or L that’s sold in your state by any insurance company. If eligible for Medicare after 1/1/2020: Medigap Plan A, B, D, G, K and L *Note: Plans C and F are no longer available to people new to Medicare on or after January 1, 2020. People new to Medicare on or after January 1, 2020 have the right to buy Plans D and G instead of Plans C and F.	Member can apply up to 60 calendar days before the date their health care coverage ends and no later than 63 days after their health care coverage ends. Medigap coverage can't start until the Medicare Advantage Plan coverage ends.

Thank you,
Carly Maldonado
Broker Relationship Executive | Medicare Supplement & IDV
502-313-7967
www.ignitewithhumana.com

 

[rmhaire]

It might be state specific. The way it's supposed to work is if they're eligible for Medicare before 01/01/2020 and want to do GI, they have to go with Plan F. If eligible after 01/01/2020, they have to go with G.

Humana recently sent this.

Carly Maldonado
From:[email protected]

Fri, Nov 8 at 8:21 AM


Hello trusted partner,

I wanted to send a quick reminder about using the guaranteed issue (GI) right for a med supp when you have an MAPD plan exit. Please remember that Humana follows MACRA regulations. This means that anyone who had Medicare A and/or B before 2020 cannot use GI into a plan G or N. Anyone with Medicare A and/or B after 2020 can use the GI right to get a plan G. Plan N does not allow GI on a plan exit. Here is the federal rule, please call me with questions:

GUARANTEED ISSUE RIGHTS TRIGGERED BY A CIRCUMSTANCE AS REFLECTED IN THE CHOOSING A MEDIGAP POLICY PUBLICATION (STATE SPECIFIC GI RIGHTS MAY BE AVAILABLE)	AVAILABLE GUARANTEED PLANS AS REFLECTED IN THE CHOOSING A MEDIGAP POLICY PUBLICATION (SPECIFIC STATE REQUIREMENTS APPLY AND ADDITIONAL PLANS MAY BE REQUIRED)	WHEN TO APPLY WITH GUARANTEED ISSUE
	Please note: members in CA, ME, NJ, OK, OR and TN can apply for any plan* available in the state. *Plan C and F are no longer available to people new to Medicare after January 1, 2020.
Applicant's Medicare Advantage plan is leaving Medicare, stops giving care in member's area, or member moves out of plan's service area.	If eligible for Medicare prior to 1/1/2020: Medigap Plan A, B, C*, F*, K, or L that’s sold in your state by any insurance company. If eligible for Medicare after 1/1/2020: Medigap Plan A, B, D, G, K and L *Note: Plans C and F are no longer available to people new to Medicare on or after January 1, 2020. People new to Medicare on or after January 1, 2020 have the right to buy Plans D and G instead of Plans C and F.	Member can apply up to 60 calendar days before the date their health care coverage ends and no later than 63 days after their health care coverage ends. Medigap coverage can't start until the Medicare Advantage Plan coverage ends.

Thank you,
Carly Maldonado
Broker Relationship Executive | Medicare Supplement & IDV
502-313-7967
www.ignitewithhumana.com

When I first read this I thought it read circumcise instead of circumstance.

I was like nope. Not again.

 

[Cdevin]

So reading your response "Humana follows Macra regulations" seems to imply that some companies do not. And that is what the client said to me too, they said they had spoken to Medico, and Medico said something like "MACRA is just a suggestion". Is there anywhere that this is published by the insurance company? What companies do, what companies don't? They said they had spoken to Humana and Medico, but specifically referred to Medico. But again, I have seen Allstate give ppl G when it should be F. And somehow they got a N?

 

[LostDollar]

With that said this year I have been seeing some weirdness. States giving GI G when it should be F, for example Allstate in FL only offered the F through UW, but allowed GI G on two people whose A date was like 2014. Ok, one company and a one off.

In terms of understanding your problem, I think maybe you should be careful about saying states when it is a carrier (or carriers) taking the action.

 

[LostDollar]

So reading your response "Humana follows Macra regulations" seems to imply that some companies do not. And that is what the client said to me too, they said they had spoken to Medico, and Medico said something like "MACRA is just a suggestion". Is there anywhere that this is published by the insurance company? What companies do, what companies don't? They said they had spoken to Humana and Medico, but specifically referred to Medico. But again, I have seen Allstate give ppl G when it should be F. And somehow they got a N?

Again, a bit of care there. That was Humana's response quoted by goillini, not goillini's response.

 

[LostDollar]

I wonder if a carrier accepting G or N on a GI basis instead of F is another one of those Medicare situations where carriers can adopt a more liberal procedure than the Federal rules modified by the state in question require if the carrier chooses to do so?

That is what cdevin's comments suggest to me.