Open Enrollment Period...What Can I Do?

[Jessica Durphy]

I have a lady that has a PFFS coupled with a stand alone PDP. She had a brain tumor that was not cancerous (3 yrs. ago), with surgery it was removed and she's had no issues since. After the surgery, though, she started getting blood clots... the dr. put her on blood thinners to help that situation. All is well now!! She's 61, on SS disability... and she told me that all of the Dr. bills are killing her. I take it because she has a PFFS, the drs. must not be accepting Medicare's terms and conditions, maybe that's why she's getting tons of dr. bills.

Anyway, my question is.... am I allowed to sell her a Medicare supp? I think that I'm allowed, but I wanted to make 100% for sure.

ALSO... if perhaps she's denied for a Medicare supp, it wouldn't affect me trying to get her into a different Medicare Advantage would it???

Sorry if this question seems so silly or elementary, but I'm getting terribly confused, seems like I'm getting several different answers! Some say I can't and some say that I can....

 

[jdeasy]

I have a lady that has a PFFS coupled with a stand alone PDP. She had a brain tumor that was not cancerous (3 yrs. ago), with surgery it was removed and she's had no issues since. After the surgery, though, she started getting blood clots... the dr. put her on blood thinners to help that situation. All is well now!! She's 61, on SS disability... and she told me that all of the Dr. bills are killing her. I take it because she has a PFFS, the drs. must not be accepting Medicare's terms and conditions, maybe that's why she's getting tons of dr. bills.

Anyway, my question is.... am I allowed to sell her a Medicare supp? I think that I'm allowed, but I wanted to make 100% for sure.

ALSO... if perhaps she's denied for a Medicare supp, it wouldn't affect me trying to get her into a different Medicare Advantage would it???

Sorry if this question seems so silly or elementary, but I'm getting terribly confused, seems like I'm getting several different answers! Some say I can't and some say that I can....

During OEP she can change to "like" plan. For example, she can go to another stand alone PFFS or she can go to an MAPD whether it's PFFS or HMO/PPO. She cannot go to an HMO/PPO that does not have drug coverage. She entered OEP with drug coverage, she must leave OEP with drug coverage.

If the Doctor is accepting her PFFS, they are being paid whatever the Medicare reimbursement is, minus whatever copay they received from the patient.

She could drop her PFFS to sign up for a mud sup during OEP. She is gonna pay a hefty premium for a med sup since she is underage. She would also have to qualify for a med sup. I don't know what the underwriting is like on the plans you offer, but, a brain tumor and blood thinners, {Coumadin?}, would be a deal killer with mine.

If she is going to a Doctor that does not accept her PFFS, she has to pay full price. The plan won't pay anything if the person sees a doctor that won't accept the terms and conditions of the plan, except, of course, in emergencies. The Doctors cannot bill her for anything over and above the copays.

 

[Jessica Durphy]

Jdeasy... thank you for your response! I asked an underwriter for the company that I write for... this was her explaination:

Hi Jessica,
I spoke w/ Janie on this case. She said that w/ appl. we need something from dr. explaining that brain tumor was not cancerous & that her blood clots have completely dissolved. She also made mention that approval is still determined by Telephone Interview as well.

I didn't want to waste this lady's time and write up an application, just to have it denied. I can get her into a Med. Supp at her age, being a non tobacco user, for only $86.94 a month. WHICH IS BEAUTIFUL~ but her health issues may keep her from getting it.
I definitely want to get her out of a PFFS, because she's not happy with it. I'm meeting with her Saturday am at 9:00.... and I want to discover all of my options before settling with another MAPD.

 

[VaDwayne]

Jdeasy... thank you for your response! I asked an underwriter for the company that I write for... this was her explaination:

Hi Jessica,
I spoke w/ Janie on this case. She said that w/ appl. we need something from dr. explaining that brain tumor was not cancerous & that her blood clots have completely dissolved. She also made mention that approval is still determined by Telephone Interview as well.

I didn't want to waste this lady's time and write up an application, just to have it denied. I can get her into a Med. Supp at her age, being a non tobacco user, for only $86.94 a month. WHICH IS BEAUTIFUL~ but her health issues may keep her from getting it.
I definitely want to get her out of a PFFS, because she's not happy with it. I'm meeting with her Saturday am at 9:00.... and I want to discover all of my options before settling with another MAPD.

Where in the world are you going to get a disability(underage) Medicare supplement for $87.00 a month? She can make 1 change into an MA or Med Supp.during the OEP but she must keep PDP. If she is under 65 she is going to have to get a disability Medicare supplement and I just can't believe that she is getting one for that price. Did you quote a premium for a regular med supp or a disability med supp? If it $87, that is awesome.

 

[jdeasy]

Jdeasy... thank you for your response! I asked an underwriter for the company that I write for... this was her explaination:

Hi Jessica,
I spoke w/ Janie on this case. She said that w/ appl. we need something from dr. explaining that brain tumor was not cancerous & that her blood clots have completely dissolved. She also made mention that approval is still determined by Telephone Interview as well.

I didn't want to waste this lady's time and write up an application, just to have it denied. I can get her into a Med. Supp at her age, being a non tobacco user, for only $86.94 a month. WHICH IS BEAUTIFUL~ but her health issues may keep her from getting it.
I definitely want to get her out of a PFFS, because she's not happy with it. I'm meeting with her Saturday am at 9:00.... and I want to discover all of my options before settling with another MAPD.

By all means get her into a med sup then. I can't believe that rate. The rates for an underage here in Ky start at around $240/mo.

She can't leave the MA until Jan. 31. So, make the sup effective Feb. 1. Be sure to get her disenrolled from the PFFS or the med sup won't/can't pay the bills.

 

[Jessica Durphy]

She's been on disability for a few years, she's got a PFFS plan, which is what she's had (I guess from the beginning?!?) I'm not sure..

The company I write with has a price sheet, That sheet lists: zip code, tob or non tob use, female, male, age, and price. IFFFF she can get through underwriting with her issues, then yes, I can get her a rate of $86.94. I've done so once before...basically the same situation... a lady was 63, because of rhum. arthritis she was on disability, got a premium of $92. and some change...but she was a tobacco user. They approved her and she paid the first months premium along with the application...and she's tickled pink with her coverage.

 

[ksigmtsu]

By all means get her into a med sup then. I can't believe that rate. The rates for an underage here in Ky start at around $240/mo.

She can't leave the MA until Jan. 31. So, make the sup effective Feb. 1. Be sure to get her disenrolled from the PFFS or the med sup won't/can't pay the bills.

They're wildly different state by state. Tennessee dosen't allow underage at all. I actually suggested to someone the other day to move (temporarily) to a state that did because then they could move back to Tennessee or wherever they wanted and keep the med supp, and it was a 45 year old disability case with multiple strokes and paralysis and tremors that occurred constantly without medication, she has neurologist appts once a month, and if they'd move to someplace like pennsylvania for a year she could get a F suppliment and save a boatload of money over the next 20 years.

 

[Jessica Durphy]

They're wildly different state by state. Tennessee dosen't allow underage at all. I actually suggested to someone the other day to move (temporarily) to a state that did because then they could move back to Tennessee or wherever they wanted and keep the med supp, and it was a 45 year old disability case with multiple strokes and paralysis and tremors that occurred constantly without medication, she has neurologist appts once a month, and if they'd move to someplace like pennsylvania for a year she could get a F suppliment and save a boatload of money over the next 20 years.

wow, can't say I've ever had a situation like that, but I don't feel you did a dis-service to that lady. You gave her your opinion and she took it! Did it help her?? You better believe it! Good job

 

[DS4]

I can get her into a Med. Supp at her age, being a non tobacco user, for only $86.94 a month.

I think you left a 1 or a 2 off the beginning of that rate quote?? If not, I've NEVER heard of a disability med supp costing that much.
If that rate quote is correct, you can expect underwriting to be VERY strict As in, if this lady can't run the mile in under 5 minutes, she is declined.

 

[arnguy]

What company is that you are quoting, Jessica?