Replacing MA with Med Supp After Jan 1st

[jdeasy]

She could even go back after OEP if this is her first time in an MA, couln't she?

Winter

Yes, providing she was in the 12 month window.

 

[Frank Stastny]

guys, please stop assuming things. I did say PFFS in my original post. I didn't mention anything about a drug plan because i've had her on a Coventry PDP for a few years now. She's set with that. This situation is the very reason why I NEVER couple an MA and PDP together into one plan. One of the plans may still fit the client needs while the other does not. Nope, have never sold an MAPD and never will. I have plenty of MA plans and plenty of PDP plans, but never and MAPD.

I guess I'm missing something.

She has a PFFS plan now, you said she wants to "go back to a Med Supp". She is within the twelve month period where she can go back to her Med Supp and have it be guaranteed issue, isn't that correct? By what you said, I am assuming that she formerly had a Med Supp right?

If that is the case you can put her back with the same company and plan as of Jan 1 regardless of the surgery. If you want to place her with a different company then she will probably have to answer the health questions and you should wait until after the surgery to write the app with an effective date a couple of weeks after the surgery.

This may mean that she has to "go bare" for a couple of weeks with only Medicare as her coverage. To me, that isn't a whole lot different than having a PFFS plan.

I don't sell MA/PFFS plans so I have never encountered that situation but it seems pretty cut and dry to me. Then again I may not know what in the hell I'm talking about.

 

[jdeasy]

I guess I'm missing something.

She has a PFFS plan now, you said she wants to "go back to a Med Supp". She is within the twelve month period where she can go back to her Med Supp and have it be guaranteed issue, isn't that correct? By what you said, I am assuming that she formerly had a Med Supp right?

If that is the case you can put her back with the same company and plan as of Jan 1 regardless of the surgery. If you want to place her with a different company then she will probably have to answer the health questions and you should wait until after the surgery to write the app with an effective date a couple of weeks after the surgery.

This may mean that she has to "go bare" for a couple of weeks with only Medicare as her coverage. To me, that isn't a whole lot different than having a PFFS plan.

I don't sell MA/PFFS plans so I have never encountered that situation but it seems pretty cut and dry to me. Then again I may not know what in the hell I'm talking about.

The original poster has never said that she is still in the 12 month wondow. He did say that she was formerly on a med sup.

Just reading between the lines, I'm thinking she is not still in the 12 month trial period and that's what raises the concern about the pre X.

If she is outside the 12 month trial, she can only drop her PFFS during AEP or OEP unless she qualifies for some SEP. That was his original question.

 

[Frank Stastny]

The original poster has never said that she is still in the 12 month wondow. He did say that she was formerly on a med sup.

Just reading between the lines, I'm thinking she is not still in the 12 month trial period and that's what raises the concern about the pre X.

If she is outside the 12 month trial, she can only drop her PFFS during AEP or OEP unless she qualifies for some SEP. That was his original question.

Thanks, I guess I assumed too much. It is so much easier to answer a post when all the information is clearly stated and one doesn't have to guess to try to fill in the blanks.

For my information, can she have the surgery under her PFFS plan in January then drop it effective the end of January? Wouldn't that still be under either the AEP or OEP when she can drop her policy?

If so then can't she apply for the Med Supp literally the day after the surgery and have it go into effect on Feb 1?

This is only one of the many reasons I don't sell PFFS plans.

Thanks JD.

 

[Winter_123]

Thanks, I guess I assumed too much. It is so much easier to answer a post when all the information is clearly stated and one doesn't have to guess to try to fill in the blanks.

For my information, can she have the surgery under her PFFS plan in January then drop it effective the end of January? Wouldn't that still be under either the AEP or OEP when she can drop her policy?

If so then can't she apply for the Med Supp literally the day after the surgery and have it go into effect on Feb 1?

This is only one of the many reasons I don't sell PFFS plans.

Thanks JD.

Could probably even apply before the surgery and have it go into effect the first of Feb 1. The question at hand though is: Does "go into effect" include pre-exist or not. Arguably not, unless she is still within her first original year in an MA. Perhaps, the original poster could clarify that rather than have everyone continue to read tea leaves while trying to help.

 

[jdeasy]

Thanks, I guess I assumed too much. It is so much easier to answer a post when all the information is clearly stated and one doesn't have to guess to try to fill in the blanks.

For my information, can she have the surgery under her PFFS plan in January then drop it effective the end of January? Wouldn't that still be under either the AEP or OEP when she can drop her policy?

If so then can't she apply for the Med Supp literally the day after the surgery and have it go into effect on Feb 1?

This is only one of the many reasons I don't sell PFFS plans.

Thanks JD.

The OEP is from Jan. 1 thru March 31. She can return to original Medicare during this time. She can change to another MA plan during this time. Since she has a PDP, she could even go to an MAPD during that time. None of those seem to be options she is considering, but, she could. The one thing she cannot do is drop her PDP plan or go to another stand alone PDP. Again, that doesn't appear to be a concern anyway.


Yes, anytime in Jan. she can drop the PFFS by going back to original Medicare. Her coverage under the PFFS wouldn't end until Jan. 31. She could go ahead and purchase a med sup to be effective on Feb. 1 and not lose a day of coverage.

 

[Frank Stastny]

The OEP is from Jan. 1 thru March 31. She can return to original Medicare during this time. She can change to another MA plan during this time. Since she has a PDP, she could even go to an MAPD during that time. None of those seem to be options she is considering, but, she could. The one thing she cannot do is drop her PDP plan or go to another stand alone PDP. Again, that doesn't appear to be a concern anyway.


Yes, anytime in Jan. she can drop the PFFS by going back to original Medicare. Her coverage under the PFFS wouldn't end until Jan. 31. She could go ahead and purchase a med sup to be effective on Feb. 1 and not lose a day of coverage.

Damn you are good!

Sounds like you are the only one who really answered his original question.

Just like "shake an bake" I helped a little didn't I?

 

[Todd King]

The OEP is from Jan. 1 thru March 31. She can return to original Medicare during this time. She can change to another MA plan during this time. Since she has a PDP, she could even go to an MAPD during that time. None of those seem to be options she is considering, but, she could. The one thing she cannot do is drop her PDP plan or go to another stand alone PDP. Again, that doesn't appear to be a concern anyway.


Yes, anytime in Jan. she can drop the PFFS by going back to original Medicare. Her coverage under the PFFS wouldn't end until Jan. 31. She could go ahead and purchase a med sup to be effective on Feb. 1 and not lose a day of coverage.

Yes, this is the answer. I'm sorry if I didn't give enough info to begin with. I was really trying to keep it simple. I know all of the other stuff that was posted here about the PDP and the 12 month guarantee and all. I was only concerned whether or not I could change her after the AEP and during the OEP. I thought I could but was just looking for a little backup on my thoughts. Either way though, somebody else might read these posts and get answers that they need. So it's probably a good thing that there were answers for all kinds of scenerios. Thanks all for contributing.

 

[Frank Stastny]

Yes, this is the answer. I'm sorry if I didn't give enough info to begin with. I was really trying to keep it simple. I know all of the other stuff that was posted here about the PDP and the 12 month guarantee and all. I was only concerned whether or not I could change her after the AEP and during the OEP. I thought I could but was just looking for a little backup on my thoughts. Either way though, somebody else might read these posts and get answers that they need. So it's probably a good thing that there were answers for all kinds of scenerios. Thanks all for contributing.

When it comes to all the crap that CMS is dumping on agents there is no question that shouldn't be asked and even answers slightly "off topic" should always to be considered a good thing.

One should never let a day go by without trying to learn something new.

It's comforting to know that we can come here and find someone to bounce questions and thoughts off of. As in having someone to "cover our six".

 

[retread]

When it comes to all the crap that CMS is dumping on agents there is no question that shouldn't be asked and even answers slightly "off topic" should always to be considered a good thing.

One should never let a day go by without trying to learn something new.

It's comforting to know that we can come here and find someone to bounce questions and thoughts off of. As in having someone to "cover our six".

Yes... good point(s).

Let me leave with the following to ponder: I think of the AEP mainly applying to PDPs and MSAs. We have from Nov 15th to March 31st to sell MAs to over 65s and all year to sell Med Sups and SNPs to all benes, as well as everything to T-65s, no holds barred! I adjust my sales strategies accordingly, adding in other insurance, too.

Knowing the rules for PDPs is the key. Same rules apply to MSAs. By extension, how they apply to MAs during the OEP...