Medicare Advantage

TheSalesWolf,

See why I don't recommend nor sell PFFS plans.

No matter who or what company you ask it seems like the answer is always different.

If you are going into he Senior Market, do it with Medicare Supplement policies. Both you and your client will be a lot happier and better protected.

That is just my personal opinion and suggestion.
 
Well don't just tell me I'm wrong, fill me in!!!

On the second statement, how much time are you allowed to make your choice?:no:
You are ALMOST correct. If you go into an MA plan for the 1st time from a Med Supp, you have 12 months to return to the SAME PLAN with the SAME carrier.

We're having some question if United World is making an exception to this but what I am stating is per CMS.

Rick
 
I think you have a guarantee to re-enter Medicare on the same plan by any carrier? Meaning, if you go from Plan F to MA then leave the MA within 12 months, you have GI of a Plan F from any carrier.
or
If you age in straight to MA then you chose to leave MA within 12 months you have GI just like initial enrollment.


On #1, the only way you can go to a new carrier(without answering health questions) is if your old carrier no longer provides med supps.

On # 2, you are right If you chose a MA in the OE then you have 12 months to bail out and get med supp GI. I am not sure what you were askin about time frames though.:GEEK:
 
Sorry it has taken me a bit to join in Frank. I was on vacation and am slowly getting back into the groove.

A Medicare bene can get orig Medicare back if they leave their MAPD plan within 12 months of joining. However, this has to be their first enrollment in a MA plan. If they have had another MA in the past, they do not get the 12 month change.

They can get their old supp back underwriting free within the 12 months. If they did not have a supp, the supp company does not have to take them. In that case, call AARP.

Why I sell them? They work in metro area more so then in rural markets. This is due to:
- Networks - they are HMO and PPO's with big networks
- Money - They work in poorer urban areas where supps are unaffordable

The 2 big carriers in KC (Humana and Coventry) don't market PFFS plans, only HMO and PPO. PFFS are there, just not marketed.
 
They can get their old supp back underwriting free within the 12 months. If they did not have a supp, the supp company does not have to take them. In that case, call AARP.

Why I sell them? They work in metro area more so then in rural markets. This is due to:
- Networks - they are HMO and PPO's with big networks
- Money - They work in poorer urban areas where supps are unaffordable

Good to have you back.

I thought those were the rules and regs but I wasn't sure.

I had a situation earlier this year where a United World agent convinced a husband and wife, clients of mine, to cancel their Med Supp with me and take a World policy. He did this in late December and told them to cancel my policy effective Jan 1, 2007. They cancelled mine and went to Gulf Port for three months.

When they returned they each had a letter saying World declined their applications. They are both in poor health. She called me in a panic and told me what happened. I told her that it had been more than 60 days since they cancelled and could not get their policies back without answering health questions. Neither of them would be able to do that. (I'm sure they told the World agent about their health problems but he wrote the app anyway, and told them to cancel my policy immediately.)

I had no choice except to put them with Pyramid. (Those are the only PFFS plans I have written this year.)

I have been told that I can put them back on the Med Supp as guar. issue. I really question that. Is that true?

If I was still living in St. Louis I would sell the Advantage plans also. I just don't think they are a good deal for people in rural Missouri.
 
I would rather have it direct from the carrier also. SMAN said that he called them direct and they said they could go to any company. SOmeone either mis understood United WOrld or someone was bluffing. I believe you Rick. I am not arguing about what CMS guidelines are because you are correct. SMS thinks different and so does SMAN. I don't see how the application can slip through as GI.

Since my name has been brought up a few times, I figured I'd jump in the fray(sp?). The OP was asking about someone going on an Advantage plan at 65 and then switching to a Med Supp. The rule is that in the first 12 months, they can leave the Advantage plan and get a Med Supp guarantee issue (with any carrier).

The second topic being discussed (somehow it got a little off the original topic) is if someone leaves a Med Supp for and Advantage plan (for the first time) and then decides they want to go back to the Med Supp within 12 months. The Federal law is that they can get their original Med Supp back guarantee issue. If that Med Supp isn't available, they can get one with another carrier guarantee issue (certain plans apply).

Up until recently, United World was accepting someone who previously had a Med Supp, left for an Advantage plan and then went back to a Med Supp within 12 months. I have personally done this. Whether it "slipped" through the cracks or was just their common practice I don't know.

Now they are saying the client needs to get their old Med Supp back. Of course, this was the rule all along, but they were still taking these people. I don't know if they will continue to accept them or enforce the original rule. Suffice it to say, it's much clearer when everyone sticks to the letter of the law.

Now, to the original poster as to why anyone would recommend an Advantage plan. They are a viable alternative to a Med Supp when someone can't afford a Med Supp or qualify for a Med Supp. Not all Advantage plans are made the same. It is our job to analyze every plan available and make a recommendation as to what's best for the client. I always recommend a Med Supp over an Advantage plan. But as I stated, not everyone can afford it. And some just want to take on more cost sharing in order to save premium dollars.

That's my 2 cents.
 
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