Nursing Home SEP

[walleyeb1]

Does entering a nursing home create a SEP for a client that is in a MAPD plan? If so could the client switch to medicare, a supplement and a part D plan? I know it would all have to be coordinated and I have a med supp company that is guarantee issue so that won't be a problem.

Thanks!

 

[jdeasy]

Does entering a nursing home create a SEP for a client that is in a MAPD plan? If so could the client switch to medicare, a supplement and a part D plan? I know it would all have to be coordinated and I have a med supp company that is guarantee issue so that won't be a problem.

Thanks!

Yes, it creates an SEP to leave the MAPD. They can switch to original medicare and must pick up a PDP. Once on medicare, if you have a company that will cover a person with a med sup that is in a nursing home, you are good to go.

 

[allhealthandlife]

Does entering a nursing home create a SEP for a client that is in a MAPD plan? If so could the client switch to medicare, a supplement and a part D plan? I know it would all have to be coordinated and I have a med supp company that is guarantee issue so that won't be a problem.

Thanks!

Make sure they don't have Medicaid first.About 50% of people entering nursing home have spent down assets to get Medicaid to pay for ltc .If so no supplement needed.If person is entering nursing home as a skilled nursing care patient be careful because some Med Supp carriers like AARP/UHC will not cover stays in SNF that started before effective date of coverage.

 

[Russ]

If person is entering nursing home as a skilled nursing care patient be careful because some Med Supp carriers like AARP/UHC will not cover stays in SNF that started before effective date of coverage.

So true. I had that happen with AARP 1-2 years ago with a policyholder.

 

[allhealthandlife]

So true. I had that happen with AARP 1-2 years ago with a policyholder.

I found out the hard way myself.I thought when they said all pre existing conditions are covered that included IP hospital and SNF stays. I actually brought this up at a meeting with a manager from AARP/UHC Medicare supplement division and he at first told me that it would be covered and when I pressed a little harder and said are you sure he said he will get back to me.He called me and said he was mistaken it would not be covered.And get this - he said the SNF claim should be covered by the policyholders previous group insurance even though the policy had terminated before he left the the SNF confinement had ended.This is one difference between the AARP group certificate issued policie vs the individual guarenrenteed renewable policy.Of course no other Med Supp carrier in Florida would have aproved him for coverage so be able to write the AARP supplement has been a blessing for the last two years.