SEP Question

May 29, 2008

  1. insurance0707
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    insurance0707 Guru

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    I have a client that turned 65 last November and went on Medicare for the first time. I enrolled her in a MAPD. She would like to change it to a Medicare supplement and PDP plan instead.

    I'm pretty sure when people first turn 65 and enroll in a MAPD plan they have a 12 month trial period. If they're not happy they can cancel it and go with a Med supp/PDP plan instead.

    Does anyone know if it's difficult to make the change? Has anyone had a similar situation?

    thanks in advance
     
  2. GreenSky
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    It's never been a problem for me to do that. She does have a SEP so the PDP will issue a plan. The supp is no issue at all.

    Rick
     
    GreenSky, May 29, 2008
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  3. Guest
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    Guest Guest

    rick is correct, i've alot of these
     
    Guest, May 30, 2008
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  4. insurance0707
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    Thanks guys!
     
  5. retread
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    Rick is right (as usual)! The first 12 months for a first time Medicare Advantage plan of any sort is called a "trial period". If they chose something else, it qualifies as a "trial SEP". Since an SEP is established, a PDP can therefore be issued.

    CORRECTION: T-65s switching back to Original Medicare and want a Med Sup are GI with ANY Med Sup sold in their state.

    (66+) Others wanting to return to Med Sup have the right to their old policy (including Rx if grandfathered). If that policy is not still being offered by your old company, then they are still GI with ANY Med Sup sold in their state, but only plans A, B, C, F, K, or L.

    My apology to anyone viewing my former post. I had this bass ackwards.
     
    Last edited: May 31, 2008
    retread, May 30, 2008
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  6. insurance0707
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    what about someone that's 70 had Bankers Life, went to an MAPD for the first time and wanted to leave it within the first 12 months.....do they have to go back to Bankers Life or are they guaranteed issue with any Med supp?
     
  7. retread
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    No, they do NOT have to go back to their original carrier. As a matter of fact, they are GI with any Med Sup in their state of residence that offers either A, B, C, F, K,or L.

    The rules are found on p.19 of the 2008 Choosing a Medigap Policy (CMS). WHICH IS REQUIRED TO BE GIVEN TO YOUR PROSPECTS.
     
    Last edited: May 31, 2008
    retread, May 31, 2008
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  8. senior-advisor-indiana
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    Wrong,

    They are only GI if they go back to Banker's Life(or previous med supp), unless Banker's(or previous med supp)does not offer that plan anymore. But, they could go to United World because they do allow that. That is the only company I am aware of to where they could get GI.:GEEK:
     
  9. Winter_123
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    Huh? I don' think so.

    Winter
     
  10. retread
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    Tell you what, guys. Read the rules again. "Rights" is not a mandatory requirement. CMS allows a beneficiary the "right" to go back to the original carrier, not a requirement. IF the beneficiary wants the original plan back, he is entitled to because that's his "right". I went around with underwriting about this a couple of months ago, and they took your position, but called me back later and apologized and said they were wrong. But I wouldn't bet they wouldn't change their mind again...

    Maybe I am wrong... but that's the way I read the rules. If I need to be corrected, then I will stand corrected.
     
    retread, Jun 1, 2008
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