Got a quick question: I have a client who had an expensive Plan F in 2023, and switched to MAPD for the first time on Jan 1st, 2024, so he is in the one year trial period right now. He wants to switch back to MedSupp on Sept 1st, but he does not want to go back to his old MedSupp. He is really healthy, has no medical issues and takes no drugs. Does he have to go back to his old MedSupp using the GI benefit, or can he choose to go through underwriting and apply for any MedSupp he wants to?
Switching from MedSupp to MAPD during trial year
- Thread starter Nikita
- Start date
Special Agent
Guru
- 366
The trial period sep is what allows change from mapd to pdp outside the AEP/OEP.they can enroll in any med supp they can qualify for if you they don't need GI .Get approval for med supp first before you submit pdp
I don't have the rules in front of me, but I believe he has to go back to the plan he had before (but not necessarily the carrier) in order to qualify for GI
It varies by state and carrier.
Federal (CMS) rules state you have to go back to your former plan and carrier . . . but there are no prohibitions that I am aware of from offering a more lenient program.
Read the GI section for the app of the carrier you plan on using.
Also, depending on the carrier and state, your compensation may be slightly above $0.
Federal (CMS) rules state you have to go back to your former plan and carrier . . . but there are no prohibitions that I am aware of from offering a more lenient program.
Read the GI section for the app of the carrier you plan on using.
Also, depending on the carrier and state, your compensation may be slightly above $0.
William Martinica
New Member
- 6
If he's healthy go through UW and most likely he will get a lower rate with a diff carrier, depending on how many carriers you work with. If you GI him like Somarco said it's gotta be the same plan and carrier and you won't get paid on it.
You have work coverage . Plan A the $5 k deductible is $230 a month . Plan B $500 decuctible is $600 a month . 90% pick plan A . Same principal with mapd vs med sup . All these yrs you argued with yourself . Not one agent will argue what’s better coverage if YOU HAVE THE MONEY . Unfortunately many don’t have the money . I got a call from a mapd guy just got diagnosed with cancer . He was bitching about the copays . He’s on lis . Even if I showed him a med sup 1 year ago he wouldn’t have bout it . I told him “ tell anyone asking you for copays to bill you “ . He doesn’t have the money and can’t pay even if he wanted . There lies why so many medical people hate mapd . There getting stiffed huge as few pay the bigger copays
Some 5 years or so ago I did what I thought was an underwritten app with UHC for a woman who took NO MEDS
and I got paid GI when I called I was told because UHC cares so much about the client they automatically put them in GI whenever available
So when I want underwritten for trial right I use other carriers and have not had an issue
and I got paid GI when I called I was told because UHC cares so much about the client they automatically put them in GI whenever available
So when I want underwritten for trial right I use other carriers and have not had an issue
Panda1
Expert
- 24
If he’s that healthy just do an app wherever he wants to go and see what happens. You still have a few months left for the GI.
I had a lady I think it was the first year where you could go back to OM, she was tied with another lady for my oldest customer, 97 years old and she passed under writing no problem.
But yes as “axeman” said keep eye on PDP
