Marriage is a Qualifying Life Event

Apr 14, 2016

  1. somarco
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    somarco GA Medicare Expert

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    Odd phone call from a 72 year old lady and her (new) 71 year old husband.

    Their attorney researched plans and read them the law that said marriage is a qualifying event. As such you can change your plan to whatever you want.

    Both have a PPO MA plan. Hers is with Coventry, no idea who has his plan (but I could hear him in the background feeding her questions).

    They talked with Coventry and Aetna (successor to Coventry). Whoever they talked to at both carriers said all they had to do was write a letter stating they are married and Coventry/Aetna will convert their plan to any supplement plan they want.

    Apparently they can give them a PDP as well. When I mentioned they would be losing their existing Rx and could not pick one up until years end that was news to them.

    No mention of medical underwriting either.

    Now I realize there are some things involving Medicare that are going to be new to me but this one was really strange.

    So I asked if the carrier CSR knew they were talking about Mcare and not Obamacare (which does allow an SEP for marriage).

    Their attorney said it was Mcare and the carrier knew which MA plan they had so surely the carrier gave them correct information.

    Rather than waste any more of my time and possibly run the risk of looking like a fool, I suggested they take the Coventry/Aetna offer and run with it.
     
    somarco, Apr 14, 2016
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  2. sman
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    sman Guru

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    This is news to me. Of course, I've never researched whether or not marriage is a QLE regarding MAPD or Med Supps, but I've never heard it being a reason for a Special Enrollment Period on the MAPD side and question whether it really is. If someone has proof, I'd love to see it. I welcome learning new things.

    As for the person at Aenta/Coventry telling them they just need to write a letter, I highly doubt it. I had a client who changed banks and called Aetna direct to change her payment method to quarterly (this is for the old CLI Med Supp). They started trying to get her to switch from Plan F to Plan G (she had to go with F because it was a GI case and can't qualify medically). She told them she would call me to discuss. They never mentioned that she would have to answer health questions. She didn't ask, but she was under the impression switching plans was just a formality. I explained that she would indeed have to answer the health questions and to appease her we submitted an app electronically and she was declined. While she was upset that she didn't get the lower premium plan, she appreciated me always being honest with her.

    The point of that is, these CSR's or sales reps within the company aren't always as knowledgeable as they should be. I know that's a surprise to you Bob.
     
    sman, Apr 14, 2016
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  3. somarco
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    somarco GA Medicare Expert

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    somarco, Apr 14, 2016
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  4. Cornelius
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    Those old movies are great.
     
  5. horskj
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    horskj New Member

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    Wow...and I thought I got all the weird ones.

    I have never ever seen marriage as a qualifying event to change an MA plan. I went back and looked at the CMS web site

    Medicare.gov

    and then checked a few other sources...

    healthpocket.com/medicare/special-enrollment-period

    and no where is there an SEP for marriage.


    Tell your client to get a new attorney
     
    horskj, Apr 14, 2016
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  6. somarco
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    somarco GA Medicare Expert

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    She's not my client, and probably won't ever be.

    I told her to get her plan from the people who said she could do it.
     
    somarco, Apr 14, 2016
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  7. vic120
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    I've heard a few weird ones before ( like switching Supplement with advanced cancer) where they say their agent or another agent can do it.

    My question to them has always been if that's the case then Why are you online looking for help now??

    They usually don't like that answer
     
    vic120, Apr 14, 2016
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  8. sman
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    Isn't that a question and not an answer?
     
    sman, Apr 14, 2016
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  9. vic120
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    you are correct.
     
    vic120, Apr 14, 2016
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