SEP Question

[Winter_123]

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.

The question is whether they have a right to go back to carrier other than the one they had before they signed up for the trial period with an MA. You stated that they had a GI back to any carrier that they want. They don't. Read the same page you referenced.

Unwriting is often a collection of clerks, with a few seasoned people here and there if you are lucky. It's your license. There are helpful people in home offices but there is a large, large number of dumbos. In addition, Med Supp is an area where both state law and fed rules apply so they very often give only a partial answer based on their little look-up screens. Most of them have no real working knowledge, they use a paint-by-number system to try to look up what you are asking. As mentioned, every underwriting group usually has a couple seasoned people in there who are holding the rest of the group together. If you end out talking with them then you get lucky and what I said does not apply.


Winter

 

[insurance0707]

On page 19 of the Medicare guide book it does say you have the 12 month period and you can get out of the MAPD plan. It also says your rights may last for an extra 12 months under certain circumstances. Does anyone know what these certainn circumstances are? I've notice on the AARP Med supp applications it mentions have you enrolled in an MAPD in the last 2 years?

In the Medicare guide it's a little more vauge on when you drop an existing policy to go with an MAPD. It doesn't say you have a Guarantee Issue with any company except the plan that you previously had.

 

[retread]

...In the Medicare guide it's a little more vauge on when you drop an existing policy to go with an MAPD. It doesn't say you have a Guarantee Issue with any company except the plan that you previously had.

I agree with the vagueness. However, if you read the rules going back to the "+Choice" era, the wording still says "is eligible" if the plan is still available. My point is, that the eligibility rules for the situation is currently under the Section on "Guaranteed Issue". It is assumed that the beneficiary would want to go back to what he had before electing the MA plan. The word "MUST" is NEVER used.

I stand by my interpretation discussed earlier, however, I can see how many would say his choices are predicated on whether or not his previous plan is still available.

 

[Winter_123]

I agree with the vagueness. However, if you read the rules going back to the "+Choice" era, the wording still says "is eligible" if the plan is still available. My point is, that the eligibility rules for the situation is currently under the Section on "Guaranteed Issue". It is assumed that the beneficiary would want to go back to what he had before electing the MA plan. The word "MUST" is NEVER used.

I stand by my interpretation discussed earlier, however, I can see how many would say his choices are predicated on whether or not his previous plan is still available.

You are mixing two issues together. One is the issue of "must" versus "right." No one disagrees with that. If they dont want to go back, then fine. Then there is the other issue you raise wherein it is asserted that they can go back to any carrier. They can't.

Winter

 

[senior-advisor-indiana]

Winter is right. The rest is bullsheep.

 

[insurance0707]

I'm curious about the part that says under certain cirumstances, they may have an additional 12 months of guarnteed issue when they leave an MAPD. Anyone know what the certain circumstances might be? Where would we find that info out?

 

[jerrykramer64fan]

Had this happen today. My guy turned 65 7 months ago and took a Today's Health MAPD. He decided to go with a med sup. I put him on the med sup and Today's Health said he couldn't do that and he would have to wait. He called Medicare two weeks ago and they said it's no problem, but they didn't reinstate his Medicare. Now he called Medicare again and they told him to ignore the letters from Today;s Health and they would disenroll him as of July 1st. So he's getting screwed on his med sup premium. He has the new med sup and his MAPD for one month. Why in the heck they didn't cancel his MAPD and reinstate in Medicare effective June 1st is beyond me. There is no way to get them to admit a mistake and change it since it is already June 2. Make sure your customers call Medicare to reactivate their Medicare. I don't trust any of the companies to do this properly. Any thoughts?

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[senior-advisor-indiana]

You can have the med supp company change the effective date to July 1st. I have done it plenty of times.

 

[jerrykramer64fan]

New rates kick in June first. I put him on an Admiral plan with a May 28th effective date.
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[senior-advisor-indiana]

Yeah thats awesome. They have been out 1 yr in Indiana and are taking a 15% increase. I just don't get it.