Special Election Periods Help

[alphawave2k]

Prospect is still working past 65, has Medicare Advantage and group health as well. They want to apply for a supplement + Part D. Do they have to wait until the group plan's open enrollment period to transition from group to Medsup? And since they have a Medicare Advantage plan now, would they be eligible for the SEP of 60 days max to sign up for a Medigap policy?
I don't know when their group health plan's open enrollment period is exactly, which might have also play into this scenario.
Thanks for any help.

 

[DonP]

Prospect is still working past 65, has Medicare Advantage and group health as well. They want to apply for a supplement + Part D. Do they have to wait until the group plan's open enrollment period to transition from group to Medsup? And since they have a Medicare Advantage plan now, would they be eligible for the SEP of 60 days max to sign up for a Medigap policy?
I don't know when their group health plan's open enrollment period is exactly, which might have also play into this scenario.
Thanks for any help.

I don’t think I’ve ever run into someone who is still working with a mapd and group health .He got bad advice on that . He should have done one or the other as he continued working . If he took out part B during his iep at age 65 then he has a 1 yr trial right with mapd to move back to any med sup Gi . Irregardless of when he took out his part B he could have dropped his mapd and went back to orginal medicare and got a med sup during oep that ends tommorrow.But if it’s been longer than 1 yr since he’s had his part B the new sup will be underwritten. Also some group health will not allow you to drop coverage outside there open enrollment . So the first thing he needs to do is find out if he can drop his group coverage . Also the mapd and group health have no coordination of benefits . His mapd is his insurance.

 

[somarco]

Is the EGH primary or the MA plan?

 

[alphawave2k]

Totally agree he got bad advice, hence the sour pickle they're in. He's now 73 years old and in fairly good health so I think he'll pass underwriting, but still trying to get clarification on how that will all work out given the group health termination (yes, their HR Dept needs to weigh in), and having a MAPD plan in place.

Is the EGH primary or the MA plan

EGHP is primary based on how he described his situation. A small group of less than 20, but under parent company with over 50 employees. Which makes me wonder how he would have gotten his health services? Employer plan or MAPD? or could they choose as they went. This one is a little off the beaten path for me.

 

[somarco]

A small group of less than 20, but under parent company with over 50 employees.

If the parent is providing the EGH then the group plan is primary . . . if the "direct" employer (less than 20) carries the EGH, then MA is primary.

Some EGH plans allow you to roll off the plan any time . . . some say only if a life changing event OR during the annual enrollment.

 

[DonP]

I would think the parent company provides the health insurance so the group plan is primary being 50 total . But as I said with mapd so there’s no coordination of benefits with group health . So he’s either using his group health or mapd for everything . But I’ve not seen this yet but if one of the plans found out about the other would they try to say the other has to pay ?The agent should have compared the cost of part B, his drug costs , his copays on a sup or mapd vs the cost of his employer coverage , his copays and deductible and his drug costs . I’ve found that when a person uses heavy meds there better off staying on the employer health coverage especially if there group plan only has a $3 to $4 k max out of pocket . Their drug costs go toward the moop in a group plan

 

[somarco]

Prospect needs to login to his MyMedicare account, click the NAME and scroll down to MY PLANS.

Look for A & B effective dates
Look under OTHER INSURANCE and see what shows up, also the coverage start date.

Other insurance could show the EGH or MA but should not show both.

 

[Gary in Idaho]

I have a client in a similar situation - sort of. His employer has 6 employees, so he was required to go on Medicare when he turned 65. Medicare is primary, and the employer plan (which he gets free) is secondary. He has an MA only plan, and the employer plan gets the bill for copays and provides creditable drug coverage (similar to someone who has Tricare for Life and an MA only plan). When he retires he can use LEC to enroll in a PDP. UHC tells me that he will also have GI for a med supp based on losing employer coverage, as long as he applies within 63 days.

 

[bill3173]

He will be guaranteed issue to Med Supp, but you most likely won't get paid anything(depending on the State) and you've taken him away from a free group plan, with possibly better Rx coverage.

 

[bill3173]

Prospect needs to login to his MyMedicare account, click the NAME and scroll down to MY PLANS.

Look for A & B effective dates
Look under OTHER INSURANCE and see what shows up, also the coverage start date.

Other insurance could show the EGH or MA but should not show both.

I think that's a good point, so many times you think you've got it all figured out, and then you go back to read the right info.