Med Supp Guaranteed Issue from MAPD

Slade

Expert
54
I know that insureds currently enrolled in a MAPD like Coventry's Advantra Freedom PFFS qualify for a Med Supp guaranteed issue period due to the plan being terminated.

But what about this case:

The client has been enrolled in the Humana Gold Choice PFFS H1804-081 for the past three years. This plan will no longer be available for the plan year 2010.

According to Humana, insureds who take no action will automatically be rolled into a new plan, H2944-017, rather than be automatically returned to Original Medicare.

Although this client has been happy with their MAPD coverage, even in the face of a large claim, they didn't like the nightmarish job of cross referencing EOBs with provider bills, endless EOB errors & corrections, and the mountainous piles of paper.

The client has expressed a desire to return to Original Medicare but will not qualify for a fully underwritten Med Supp.

After calling Humana and being shuffled around to seven different MAPD ?professionals?, Humans states that although this person's plan is not being renewed, they are being migrated into a new plan and therefore don't qualify for Med Supp guaranteed issue.

Is this correct?
 
I know that insureds currently enrolled in a MAPD like Coventry's Advantra Freedom PFFS qualify for a Med Supp guaranteed issue period due to the plan being terminated.

But what about this case:

The client has been enrolled in the Humana Gold Choice PFFS H1804-081 for the past three years. This plan will no longer be available for the plan year 2010.

According to Humana, insureds who take no action will automatically be rolled into a new plan, H2944-017, rather than be automatically returned to Original Medicare.

Although this client has been happy with their MAPD coverage, even in the face of a large claim, they didn't like the nightmarish job of cross referencing EOBs with provider bills, endless EOB errors & corrections, and the mountainous piles of paper.

The client has expressed a desire to return to Original Medicare but will not qualify for a fully underwritten Med Supp.

After calling Humana and being shuffled around to seven different MAPD ?professionals?, Humans states that although this person's plan is not being renewed, they are being migrated into a new plan and therefore don't qualify for Med Supp guaranteed issue.

Is this correct?


That person's plan is ending. They are entitled to a GI for a med sup.

Coventry ended several plans last year and, if you did nothing, you moved into another plan. Those folks still had the opportunity to get a med sup on a GI basis. I did several. I had to send in the letter that they got from Coventry with the med sup apps., but, everyone of them was issued.

Humana is just trying to pull another one their shady deals. Why any agent would write for them is just beyond understanding.
 
That person's plan is ending. They are entitled to a GI for a med sup.

Coventry ended several plans last year and, if you did nothing, you moved into another plan. Those folks still had the opportunity to get a med sup on a GI basis. I did several. I had to send in the letter that they got from Coventry with the med sup apps., but, everyone of them was issued.

Humana is just trying to pull another one their shady deals. Why any agent would write for them is just beyond understanding.

What jdeasy said. He is right on the money.

You will probably have to submit the letter of cancellation with the Med Supp app. To learn exactly what documentation the Med Supp company requires you may want to give the underwriting dept a call and speak to an underwriter.

Humana is BS'ing you. There ought to be a law, that is enforceable.
 
Thank you both for reinforcing what I believed to be the case. I sincerely appreciate your insight. Have a good day!
 
I know that insureds currently enrolled in a MAPD like Coventry's Advantra Freedom PFFS qualify for a Med Supp guaranteed issue period due to the plan being terminated.

But what about this case:

The client has been enrolled in the Humana Gold Choice PFFS H1804-081 for the past three years. This plan will no longer be available for the plan year 2010.

According to Humana, insureds who take no action will automatically be rolled into a new plan, H2944-017, rather than be automatically returned to Original Medicare.

Although this client has been happy with their MAPD coverage, even in the face of a large claim, they didn't like the nightmarish job of cross referencing EOBs with provider bills, endless EOB errors & corrections, and the mountainous piles of paper.

The client has expressed a desire to return to Original Medicare but will not qualify for a fully underwritten Med Supp.

After calling Humana and being shuffled around to seven different MAPD ?professionals?, Humans states that although this person's plan is not being renewed, they are being migrated into a new plan and therefore don't qualify for Med Supp guaranteed issue.

Is this correct?

Your client will absolutely qualify. After reading the post on this forum, Humana must be a real winner.
 
Just for the record...

A muckitty muck from a very large Medicare Advantage company told me that they are pushing CMS for "Mapping" of their PFFS plan terminations into either PPO or HMO plans for next year. Don't ya think that they will once again get their way? :mad:

Oh, and this would also mean Rick's mapped renewals will be SOL. Seems like these carriers have an out for people like Rick! :skeptical:
 
You will probably have to submit the letter of cancellation with the Med Supp app. .

Specifically, the ANOC "non renewal" letter that was probably rec'd by your client several weeks ago.
Non renewal of a PFFS would trigger GI back to a Med Supp even if the carrier is mapping/migrating these people to another PFFS.
 
Specifically, the ANOC "non renewal" letter that was probably rec'd by your client several weeks ago.
Non renewal of a PFFS would trigger GI back to a Med Supp even if the carrier is mapping/migrating these people to another PFFS.



Not just PFFS, any plan that is ending would give the GI.
 
Just for the record...

A muckitty muck from a very large Medicare Advantage company told me that they are pushing CMS for "Mapping" of their PFFS plan terminations into either PPO or HMO plans for next year. Don't ya think that they will once again get their way? :mad:

Oh, and this would also mean Rick's mapped renewals will be SOL. Seems like these carriers have an out for people like Rick! :skeptical:

Am I the only one that thinks this is BS. I mean they "cancel" a conract and if the client's notice got lost in the mail they are "automatically" crammed into a PPO or HMO plan without their consent, knowledge, or participation in plan selection. :no:
 
Am I the only one that thinks this is BS. I mean they "cancel" a conract and if the client's notice got lost in the mail they are "automatically" crammed into a PPO or HMO plan without their consent, knowledge, or participation in plan selection. :no:

I think calling it BS is way too kind. How about robbery, unethical, cheating and @#$%$#.

And CMS is worried about agents ripping off seniors. What a joke all their crap is when they allow companies to pull this kind of stuff.
 
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