Supplement & Employer Coverage

[steve3752]

I have two supplement guaranteed issue questions. Florida

1. Person has a group retiree MA plan and want to drop and go to supplement. Will not pass underwriting.

2. Person is working and has A & B and employer plan. Will not pass underwriting.

I normally use UHC in Florida.

Thanks

 

[straightnochaser]

Pretty sure neither will require underwriting. The MAPD is still treated as group/employer.

 

[billyb]

Not GI if the termination of coverage is voluntary. Only GI if employer no longer offers coverage.

 

[billyb]

Got a call where the guy had employer plan. He wanted a supplement because of changes in 2024 by his ex employer. I told him he would have to prove insurability and he argued with me so I called 2 companies and both said that I was correct. Only GI if he is losing coverage involuntary.

Saw a older couple today. At 65 they enrolled in a MAPD. Have had coverage with every MAPD in our area since and now wants to go back to UHC. They wanted a MS but wouldn't qualify. The husband made it sound like they didn't know about other options when they turned 65. Like it was my fault for not contacting them then. I asked who sold them their first MAPD. They said an AC repair guy that was selling insurace as a side gig. Serviced their unit and enrolled them at the same time. Enough said.

 

[LostDollar]

Not GI if the termination of coverage is voluntary. Only GI if employer no longer offers coverage.

I was curious, so I went looking. FL has an interesting wrinkle.

I think the rules disagree with you and say both are GI. Red lettering is mine, and to my way of thinking, it covers both situations you presented.

Age 65 or over: S. 627.6741, Florida Statutes requires companies to provide an open-enrollment period to accept applications and not discriminate in the pricing of the policy, regardless of the enrollee's medical history, health status, or claims experience.

The open-enrollment period for Medicare Supplement insurance begins the first day of the month a person turns 65 and is enrolled in Medicare Part B. If a birthday falls on the first day of the month, Medicare Part B coverage and Medicare supplement insurance open enrollment begins the first day of the previous month.

If the individual did not enroll in Medicare Part B upon becoming age 65 and chooses to do so at a later date, they will have 6 months from the Medicare Part B effective date in which to obtain a guaranteed issue Medicare Supplement policy. In addition, there is a 2-month period following termination of employer-based group health coverage for an individual to have the same guaranteed issue rights.

I don't see anything there narrowing the definition of termination by defining who does it.

 

[billyb]

Did you call the carrier to verify? Oh I forgot you are not an agent.

 

[LostDollar]

Did you call the carrier to verify? Oh I forgot you are not an agent.

(you didn't forget, you are just being an a$$.)

(And if I was an agent, I would not be an agent in FL. I would be an agent in KS dealing with KS rules.)

The carrier may not be following the rule the way the state legislature and insurance department intended.

The rule talks about the ending of a contract triggering GI provisions. The rule does not discuss contract ending situations where the GI provision would not apply. It just says when the contract terminates, there is a 2 month GI situation.

The rule also does not talk about the ending of employment, it just talks about the ending (termination) of coverage. (that shows me the ground behind @straightnochaser 's comment above about the MAPD.)

So, if Medigap carriers are, in fact, subject to state rules, I think your carrier(s) are incorrect when they say they don't have to do GI when the employee terminates the contract.

Unless there is already some case law or legal precedents in the system, it would take, an interest in the situation which I do not have, and money which I do not have, to resolve the question legally.

 

[billyb]

I am just saying that if you choose employer sponsored coverage when your Part B becomes effective and then years later decide to buy a Medicare supplement to replace that coverage voluntarily that then you have to go thru underwriting. No GI.

 

[Newby]

Not GI if the termination of coverage is voluntary. Only GI if employer no longer offers coverage.

That rule is state specific. In some states it’s GI even if leaving group voluntarily.

 

[LostDollar]

I am just saying that if you choose employer sponsored coverage when your Part B becomes effective and then years later decide to buy a Medicare supplement to replace that coverage voluntarily that then you have to go thru underwriting. No GI.

Caveat, I am a KS resident. I am NOT an insurance agent in KS or FL.

I have been criticized for poor reading comprehension several times, so I could be wrong, but your statement is not the way I read the FL insurance dept rules.
------------------------------------------------
First, CMS-Federal guideline
GI situation:

You have Original Medicare and
an employer group health plan
(including retiree or COBRA
coverage) or union coverage that
pays after Medicare pays and that
plan is ending.
Note: In this situation, you may
have additional rights under state
law.

https://www.medicare.gov/publications/02110-medigap-guide-health-insurance.pdf
Page 22
------------------------------------------------
Second: FL (I have broken the quote into segments so everything displays without scrolling)

S. 627.6741, Florida Statutes requires companies to provide an open-enrollment period to accept applications and not discriminate in the pricing of the policy, regardless of the enrollee's medical history, health status, or claims experience.

The open-enrollment period for Medicare Supplement insurance begins the first day of the month a person turns 65 and is enrolled in Medicare Part B. If a birthday falls on the first day of the month, Medicare Part B coverage and Medicare supplement insurance open enrollment begins the first day of the previous month.

If the individual did not enroll in Medicare Part B upon becoming age 65 and chooses to do so at a later date, they will have 6 months from the Medicare Part B effective date in which to obtain a guaranteed issue Medicare Supplement policy. In addition, there is a 2-month period following termination of employer-based group health coverage for an individual to have the same guaranteed issue rights.

To my mind, this says, in FL, there is a Medigap GI right for Medicare Beneficiaries who have Part B in effect when their employer coverage ends.

This would seem to make both OP's FL prospects eligible for GI Medigap coverage if they drop their employer coverage.

[EXTERNAL LINK] - Medicare Supplement Insurance Overview
Under open enrollment periods:
Age 65 or over: