UHC/AARP Trial Right application Question

[wehotex]

I have an Aetna PPO mb who started when he turned 65 this past March. He told me that he wants to enroll in a Med Supp. Of course, this doesn’t pay squat here in Texas (about $40/yr), but it is what he wants and the right thing to do. He told me that he had an encapsulated prostate tumor removed about 3 years ago (no exact date). One of the UW questions is asking:

Within the past 3 years, were you diagnosed with, treated, given medical advice, or
prescribed medications by a medical professional for:
• Melanoma or Metastatic Merkel Cell (but not other skin cancers)?
• Cancer (other than Leukemia, Lymphoma, or Multiple Myeloma)
Yes No Not Sure

This seems to knock him out.

The “Trial Right” option reads:

4B. Have you lost or are losing health insurance coverage or do you have a Medicare
Advantage Plan “trial right” and, if so, have you received a notice from your employer
supplement plan? or prior insurer saying that you are eligible for guaranteed issue of a Medicare
If you have a guaranteed issue right, you must provide a copy of the notice,
disenrollment letter or other documentation you received AND your Application
Form must be received no more than 63 days after the termination date of your
prior coverage. The documentation should include the type of coverage being
lost, the termination reason, the termination date and the name of the person(s)
who lost or is losing coverage.
If you have questions about your guaranteed issue rights, please see “Your Guide.”
• If YES, skip directly to

Which GI Issue Right letter are they referring to? Is it something that an MA carrier sends the 1st year member?

 

[Special Agent]

Standard disenrollment letter from ma carrier after he either cancels or enrolls in pdp
If it was a uhc ma plan he was disenrolling from uhc crosses this over had a recent case with uhc and it only about 5 days to get the gi approval.

 

[wehotex]

Standard disenrollment letter from ma carrier after he either cancels or enrolls in pdp
If it was a uhc ma plan he was disenrolling from uhc crosses this over had a recent case with uhc and it only about 5 days to get the gi approval.

So, this guy has to disenroll himself even before he gets accepted by the Med Supp?
The guru at my upline told me that a T65 can get onto ANY Plan G in Texas if first enrolled at age 65 when using this GI situation.

 

[vic120]

I dont know what letter you would get for trial right
But I do now a few years ago all I put was trial right on replacement form for the reason why they were allowed to disenroll from the MA plan outside the normal EP

And they paid me GI and a perfectly healthy person, no meds, even though I did not apply for GI

No other carrier has ever done that

They said they go above and beyond for their customers

 

[Special Agent]

So, this guy has to disenroll himself even before he gets accepted by the Med Supp?
The guru at my upline told me that a T65 can get onto ANY Plan G in Texas if first enrolled at age 65 when using this GI situation.

best practice in these cases is to give yourself a lot of time sometimes have to do a 2/1 effective but yes ultimately it is a leap of faith.If they have a member portal at aetna maybe it is possible to view letter sooner.

and of course if you try for a 1/1/25 effective you can always just cancel the pdp application up through the end of december if term letter has not been received..

 

[wehotex]

best practice in these cases is to give yourself a lot of time sometimes have to do a 2/1 effective but yes ultimately it is a leap of faith.If they have a member portal at aetna maybe it is possible to view letter sooner.

and of course if you try for a 1/1/25 effective you can always just cancel the pdp application up through the end of december if term letter has not been received..

It is not as easy as I thought it would be. Are they all like this? Is it easier if he goes with an Aetna Supp since he is already with Aetna, but delaying the cancellation?

 

[LostDollar]

I have an Aetna PPO mb who started when he turned 65 this past March. He told me that he wants to enroll in a Med Supp. Of course, this doesn’t pay squat here in Texas (about $40/yr), but it is what he wants and the right thing to do. He told me that he had an encapsulated prostate tumor removed about 3 years ago (no exact date). One of the UW questions is asking:

Within the past 3 years, were you diagnosed with, treated, given medical advice, or
prescribed medications by a medical professional for:
• Melanoma or Metastatic Merkel Cell (but not other skin cancers)?
• Cancer (other than Leukemia, Lymphoma, or Multiple Myeloma)
Yes No Not Sure

This seems to knock him out.

The “Trial Right” option reads:

4B. Have you lost or are losing health insurance coverage or do you have a Medicare
Advantage Plan “trial right” and, if so, have you received a notice from your employer
supplement plan? or prior insurer saying that you are eligible for guaranteed issue of a Medicare
If you have a guaranteed issue right, you must provide a copy of the notice,
disenrollment letter or other documentation you received AND your Application
Form must be received no more than 63 days after the termination date of your
prior coverage. The documentation should include the type of coverage being
lost, the termination reason, the termination date and the name of the person(s)
who lost or is losing coverage.
If you have questions about your guaranteed issue rights, please see “Your Guide.”
• If YES, skip directly to

Which GI Issue Right letter are they referring to? Is it something that an MA carrier sends the 1st year member?

Because it seems like the easiest possible solution to me, the first things(s) I would be doing is finding out when the surgery actually occurred (and if it was over 3 years ago, I would also get a current PSA reading). If the surgery was over 3 years ago and a current PSA reading was zero, I would answer the question no.

(That comment is based on my 20 year life experience after a similar surgery.)

His surgeon's office should be able to provide him the surgery date if he has no other information about it.

If the surgery is actually less than three years, go with whatever advice from the other agents seems best.

I don't know if cancer lookback periods are standard from one plan to another, if they aren't another possibility might be to see if there is another acceptable Medigap carrier that only has a 2 year lookback, instead of 3, for the other cancers category.

 

[Special Agent]

It is not as easy as I thought it would be. Are they all like this? Is it easier if he goes with an Aetna Supp since he is already with Aetna, but delaying the cancellation?

Because it seems like the easiest possible solution to me, the first things(s) I would be doing is finding out when the surgery actually occurred (and if it was over 3 years ago, I would also get a current PSA reading). If the surgery was over 3 years ago and a current PSA reading was zero, I would answer the question no.

(That comment is based on my 20 year life experience after a similar surgery.)

His surgeon's office should be able to provide him the surgery date if he has no other information about it.

If the surgery is actually less than three years, go with whatever advice from the other agents seems best.

I don't know if cancer lookback periods are standard from one plan to another, if they aren't another possibility might be to see if there is another acceptable Medigap carrier that only has a 2 year lookback, instead of 3, for the other cancers category.

when you complete aarp med supp electronic application if agent answers the questions correctly about previous and current coverage the system knows they have a GI and will automatically bypass underwriting questions.if an agent is answering underwriting questions in these cases they are doing something wrong.

 

[LostDollar]

when you complete aarp med supp electronic application if agent answers the questions correctly about previous and current coverage the system knows they have a GI and will automatically bypass underwriting questions.if an agent is answering underwriting questions in these cases they are doing something wrong.

(Caveat, not an agent.)

Thanks for that info.

If client is in good health otherwise, I just thought OP might be checking for a full commission option that would serve the client as well as the GI option being discussed with him. That would account for a review of carrier underwriting criteria.

My insurance forums medigap sales training says, "In a GI situation, always do at least a cursory check to see if client/prospect could pass underwriting for a full commission product sale.".

No clue about carrier and premium options, that's up to you guys.