Transition from Group Medicare to Individual MAPD

[pogo]

A man and his wife are enrolled in a KP Group Medicare Advantage plan through his employer. Both are in their 70's and both enrolled in Parts A&B years ago.

He wants to retire soon, which will end their enrollment in the group plan, and have both switch to a MAPD from a different company.

What EPs apply in a situation like this? Does he and his wife have the usual LEC SEP for the transition from employer coverage to individual coverage? Or does already being on a Medicare Advantage plan mean that they can only make changes in their plans during AEP or OEP?

 

[axeman462]

A man and his wife are enrolled in a KP Group Medicare Advantage plan through his employer. Both are in their 70's and both enrolled in Parts A&B years ago.

He wants to retire soon, which will end their enrollment in the group plan, and have both switch to a MAPD from a different company.

What EPs apply in a situation like this? Does he and his wife have the usual LEC SEP for the transition from employer coverage to individual coverage? Or does already being on a Medicare Advantage plan mean that they can only make changes in their plans during AEP or OEP?

LEC will work just fine
They will even qualify for a GI medsupp as well if they wish to go in that direction

 

[Special Agent]

A man and his wife are enrolled in a KP Group Medicare Advantage plan through his employer. Both are in their 70's and both enrolled in Parts A&B years ago.

He wants to retire soon, which will end their enrollment in the group plan, and have both switch to a MAPD from a different company.

What EPs apply in a situation like this? Does he and his wife have the usual LEC SEP for the transition from employer coverage to individual coverage? Or does already being on a Medicare Advantage plan mean that they can only make changes in their plans during AEP or OEP?

they have the the sep loss of employer coverage as long as they didn't already use it it up for switch from a "different company" if the different company was a group ma then no problem if it was an individual MA then there may be an issue

 

[pogo]

The man was in this job when he turned 65, so the LEC would apply with no problem. Although I don't think he will want medsupp, it's useful to know that he would have that option available.

The wife's situation is not so straightforward. They got married when she was already 70+, so I need to find out her Medicare status before she got coverage through his group plan. If she had an individual MAPD before getting on the group plan, what does that mean for her EP:

• Does she have only AEP and OEP available?
• Does OEP even apply for moving from group MAPD to individual MAPD?
• If neither of them makes a change before the end of OEP, would she have to wait until AEP 2025 to make any MAPD changes?

 

[axeman462]

The man was in this job when he turned 65, so the LEC would apply with no problem. Although I don't think he will want medsupp, it's useful to know that he would have that option available.

The wife's situation is not so straightforward. They got married when she was already 70+, so I need to find out her Medicare status before she got coverage through his group plan. If she had an individual MAPD before getting on the group plan, what does that mean for her EP:

• Does she have only AEP and OEP available?
• Does OEP even apply for moving from group MAPD to individual MAPD?
• If neither of them makes a change before the end of OEP, would she have to wait until AEP 2025 to make any MAPD changes?

She's still leaving a group health plan. LEC still applies. AEP will also work. If you are in the Southeast, chances are there are also multiple SEPs available as well

 

[pogo]

New scenario: if the employed man continues working, can his dependent wife use OEP to switch from the employer MAPD to an individual MAPD? (This assumes, of course, that she can leave the EGHP in mid-year—a big if, I know).