Medicare Disability beneficiary Turning 65 question

Aug 9, 2019

  1. axeman462
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    axeman462 Guru

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    came across a somewhat unique situation.

    I have a lady Turning 65, and is currently on Medicare Disability with an MAPD. She understands that the GI enrollment period for a medsupp is within 6 months of her 65th bday, and wants to wait until the last minute to enroll. (long story on why, don't feel like typing it out, but in a nut shell, shes basically trying to "game" the system.)

    I'm not sure this would work because of the 3 month window for the change from an MAPD to a PDP. Am I correct in thinking she would have to make the change within the standard 3 month window?
     
  2. vic120
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    vic120 Guru

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    OE would last 6 months so if she has other enrollment opportunities for PDP such as AEP, OEP, or An SEP she can wait.

    However always better sooner than later. Ever get those call Dec 8th Do I still have time
     
    vic120, Aug 9, 2019
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  3. somarco
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    somarco GA Medicare Expert

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    Anyone who thinks they can "game the system" and sneak one by an insurance carrier is whistling past the graveyard.
     
    somarco, Aug 9, 2019
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  4. TwoCents
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    Which 3 month window for the PDP enrollment are you referring to exactly? Since she has Medicare prior to Age 65, she'll have a 2nd IEP that will run from 3 months prior to month of Age 65, month of Age 65, and 3 months after month of Age 65.
     
  5. axeman462
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    axeman462 Guru

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    the three months after her 65th bday month.

    She wants to wait 6 months after her bday month to get a medsupp GI (she wont get through underwriting). But she still needs RX coverage. I told her, I'm pretty sure she wont be able to do it the way she wants, but I'll look into it.

    The only way I can see this working, is she switches from MAPD to PDP in the 3rd month after her bday month. Has no medsupp for 3 months, then gets her medsupp GI in month 6

    Am I wrong?
     
  6. WCMason
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    WCMason Guru

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    Not wrong except using GI when you mean OE. They’re different things.
     
    WCMason, Aug 9, 2019
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  7. axeman462
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    axeman462 Guru

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    thank you
     
  8. pfg1
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    Agree

    I'm not in that market, but I'd steer clear of anyone trying to game the system. One sale doesn't mean squat. If it was me, I'd set her up properly (where you know there is no chance of issues) or punt.
     
    pfg1, Aug 9, 2019
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  9. axeman462
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    axeman462 Guru

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    I hear ya, I'm very careful around these kinda of people. I still try, because often I can talk sense into them.
    If they don't agree to exactly my recommendations, I will refer them to the carrier's 1-800 number
     
  10. somarco
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    somarco GA Medicare Expert

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    I don't even try. Just say I can't help them and move on.
     
    somarco, Aug 9, 2019
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