Medicare Part B Deductible Question

Sep 5, 2016

Tags:
  1. Ronnie Carter
    Offline

    Ronnie Carter Guru

    Posts:
    330
    Likes Received:
    13
    State:
    Tennessee
    I feel sure this question has been addressed but a search proved fruitless. I think I know the answer but thought I'd ax the forum anyhow.

    One of my <65 and extremely disabled clients left his old UnitedHealthcare Med supp plan about 18 months ago and enrolled in a MAPD. Now due to several hospitalizations he has decided the $270/mo AARP Plan N is preferable to serving out his last two months in his MA plan before he turns 65 in November. (Of course, things will get much better for him on Nov 1 due to his T65 OEP.) His case will be GI with UHC because he left his old supp to enroll in the MAPD less than two years ago (at least that's the rule here in TN).

    So here's my question: Would his use of Part B services during the first part of this year, whilst covered by his Humana MAPD, wipe out his Part B deductible for '16, or would he still have to pay it? I think he is still liable for it but a close friend who's sold Medicare stuff for years thinks not.

    Two calls to 1-800-MEDICAR yielded two different answers. Who's surprised by that? :mad:

    What say y'all??
     
  2. bluediamond
    Offline

    bluediamond Guru

    Posts:
    2,038
    Likes Received:
    34
    MAPD replaces Medicare so he would be responsible for his deductible if he is on Medicare and a sup, depending on which sup.
     
  3. WCMason
    Offline

    WCMason Guru

    Posts:
    2,153
    Likes Received:
    304
    State:
    Colorado
    Next time your friend gets this question he'll know the right answer because you'll give it to him. One of the two Medicare reps, unfortunately, will not. The Part B deductible has not been met.
     
    WCMason, Sep 5, 2016
    #3
  4. Ronnie Carter
    Offline

    Ronnie Carter Guru

    Posts:
    330
    Likes Received:
    13
    State:
    Tennessee
    Thanks guys, I knew I'd get the straight scoop here. I thought that was the case but this guy's been around. Had me wondering.

    My client is facing two surgeries before he turns 65 in November and the hefty <65 supp premium is a whole lot less than the $500/day for five days inpatient copay.

    You know, I didn't think of it, but I could've sold him a Guarantee Trust hospital indemnity plan since he's in their 64 1/2 to 65 1/2 guaranteed issue age. I didn't get any comp for signing him up for the AARP supplement.

    BTW, how's Nucky doing? We don't see him any more on your posts!
     
  5. Midlevel
    Offline

    Midlevel Guru

    Posts:
    805
    Likes Received:
    26
    The GTL would be guarantee issue but still would have a waiting period so he wouldn't be reimbursed for the $500/day he is facing with the surgeries.
     
  6. kstein
    Offline

    kstein Guru

    Posts:
    761
    Likes Received:
    36
    Maybe a lesson on a lost sales opportunity would be write the GTL right at 64-1/2 (assuming he's on board and can delay surgery 6 months) so that way when he turns 65 he's out of the waiting period.

    I've used this opportunity a few times esp when the stars align.

    You meet with client 90 days before they t65. They say, "once I get Medicare, I'm having both knees done or some other procedure they have been delaying".

    I've written GTL on top of Plan F/G and everyone wins, minus GTL. They can keep it as long as they want and the client usually comes out ahead by $1,000+ or so in a short time frame.
     
    kstein, Sep 6, 2016
    #6
  7. yorkriver1
    Offline

    yorkriver1 Guru

    Posts:
    1,214
    Likes Received:
    28
    I have another question, because I could be faced with a situation like this some time. What about his drug plan? He can drop the MAPD 2 months before T65, and AARP is fine with the supp, but he can't have a PDP effective date until his OEP II at 65, as I understand it. Am I missing something? Or he's fine with skipping that coverage for 2 months.
     
Loading...