Wellcare, UHC... they're all out to get us

[LostDollar]

The newer medgap plans rolled out recently don't have the "free" extras and are cheaper than the ones with the "free" extras.

Caveat, not an agent.

I thought Medigap plans were standardized and all carriers must offer the same basic standard benefits. From reading here, I have gathered that Medigap carriers can, and sometimes do, offer additional benefits. However, they are not required to offer those benefits, and once an additional benefit is offered for a given year, it can be removed in subsequent years.

IMO, you are attempting to bring the entitlement mindset of MAPD clients to Medigap plans.

 

[annon123]

rmhaire I probably didn't explain my self very well.

AARP/UHC now has two versions of many of their medigap plans. The original ones claim (in their descriptions) that they offer "free" (their word on their site) added benefits beyond/in addition to the required benefits per alphabet letter (eg discounted dental, vision costs, free fitness membership). The new ones are stripped down to just the required alphabet letter benefits and none of the "extra, free" stuff the original plans had.

Client wanted to switch to the new no "extras" version as the premium is significantly cheaper. UHC stated they had to pass medical underwriting to do that (in this case original G to the new G). They don't pass. Client stated they should be allowed to switch without medical underwriting due to the Guaranteed Issues Rights. Reading the Guaranteed Issue Rights it would appear that they should be able to do so, as the client argued, because AARP/UHC mislead them to believe that those extras were free when, in fact, as based on AARP/UHC's premiums for the version that doesn't have those extras are much cheaper.

UHC states that because the new, no frills G is offered by a different subdivision/subsidiary that there is no misrepresentation and the price of G between the two offerings have nothing to do with each other. Seems like hair splitting to me but might fit the rules?

 

[rmhaire]

Caveat, not an agent.

I thought Medigap plans were standardized and all carriers must offer the same basic standard benefits. From reading here, I have gathered that Medigap carriers can, and sometimes do, offer additional benefits. However, they are not required to offer those benefits, and once an additional benefit is offered for a given year, it can be removed in subsequent years.

IMO, you are attempting to bring the entitlement mindset of MAPD clients to Medigap plans.

A few of the supp companies are trying to offer new bells and whistles. Just trying to compete with the MAPD plans. I doubt it will last too long.

I've noticed that Allstate is offering a new wearable plan. How the hell do you wear a medicare supplement?

 

[rmhaire]

AARP/UHC now has two versions of many of their medigap plans. The original ones claim (in their descriptions) that they offer "free" (their word on their site) added benefits beyond/in addition to the required benefits per alphabet letter (eg discounted dental, vision costs, free fitness membership). The new ones are stripped down to just the required alphabet letter benefits and none of the "extra, free" stuff the original plans had.

And you're missing my point. Forget about the free crap.

I've been doing medicare since 89 and life since 71. I've seen a lot. And I've been selling UHC since before they were UHC.

Forget about what Jarvis is telling you. Medigap is medigap. Fancy plan names change nothing.

Again. Forget about the free stuff. Sell insurance. People want their medical bills covered.

The free Uber rides are not nearly as important.

 

[annon123]

And you're missing my point. Forget about the free crap.

I've been doing medicare since 89 and life since 71. I've seen a lot. And I've been selling UHC since before they were UHC.

Forget about what Jarvis is telling you. Medigap is medigap. Fancy plan names change nothing.

Again. Forget about the free stuff. Sell insurance. People want their medical bills covered.

The free Uber rides are not nearly as important.

I'd agree that most people just want their medical bills paid, themselves paying as little as possible for the premiums. This client is ticked because it is highly unlikely I can find a loophole to allow them to switch to the "no frills no free stuff" G plan based on the UNH reasoning. Monday I am calling the insurance commission to see if playing the "different subsidiaries under the same parent company" game allows that with respect the argument the client used that these added free things aren't really free, thus they were mislead and thus can switch without passing medical underwriting to the other G.

 

[rmhaire]

I'd agree that most people just want their medical bills paid, themselves paying as little as possible for the premiums. This client is ticked because it is highly unlikely I can find a loophole to allow them to switch to the "no frills no free stuff" G plan based on the UNH reasoning. Monday I am calling the insurance commission to see if playing the "different subsidiaries under the same parent company" game allows that with respect the argument the client used that these added free things aren't really free, thus they were mislead and thus can switch without passing medical underwriting to the other G.

There's nothing in the insurance laws that prevents a company from starting or buying another company nor a subsidiary. In fact they do it all the time. (Think MOO and Aetna)

If you're trying to move a client from one UHC supplement to another UHC supplement then that comes under UHC's internal replacement rules and your insurance commissioner is not going to be helpful with that.

Why does it have to be UHC? Just move them to a different company. (Assuming they can pass underwriting)

We need more information on exactly what you're trying to do and more info on your client to be more helpful.

But as far as subsidiaries go, supplement carriers play that game all the time and have been since the stone age.

 

[annon123]

There's nothing in the insurance laws that prevents a company from starting or buying another company nor a subsidiary. In fact they do it all the time. (Think MOO and Aetna)

If you're trying to move a client from one UHC supplement to another UHC supplement then that comes under UHC's internal replacement rules and your insurance commissioner is not going to be helpful with that.

Why does it have to be UHC? Just move them to a different company. (Assuming they can pass underwriting)

We need more information on exactly what you're trying to do and more info on your client to be more helpful.

But as far as subsidiaries go, supplement carriers play that game all the time and have been since the stone age.

Client is 71 and fails medical underwriting for numerous reasons. Signed up at 65 in MS. Client originally wanted the community risk pool. When the client signed up only AARP/UHC has a community risk pool. Then AARP/UHC only had one G and that was with the "freebies". Client was eligible for F wanted G because no younger members would be joining over the years to keep the premiums lower in F. I explained originally and explained again that the increases were steeper the first years because they get a declining subsidy from UHC; UHC does the subsidy so the rates are more competitive when most people sign up so more people sign up thus the risk pool is larger (client complained about the rate increases since signed up; I pointed out it was less this year as no more subsidies). Due to the medical underwriting issue it is unlikely any plan will accept him without much higher rates than he is paying now in the plan he is in.

Client doesn't want the "extras". The only way out is the other G (due to community risk pool issue with him), complicated by failing medical underwriting for 3 cancers, one with no cure but a longer life span (indolent blood cancer last treated 13 years ago but has scans, etc. each year to check, other two are likely cured), heart disease just diagnosed last month (more tests mid Nov) that may need bypass surgery, etc. etc. (list of preexisting conditions is longer, includes a genetic defect that can cause health issues, long covid, neuropathy, pre diabetic, GI issues ) so any switch is likely not going to happen unless he is willing to pay much higher rates - if they even accept him.

Client was aware of these rules but thinks the Guaranteed Issues Right applies because the parent company actually isn't making the extras free since the identical plan without the extras is significantly less. As a result he thinks they violated the misleading information clause and so as a result he can switch without passing medical underwriting.

Friday I talked with several layers up the hierarchy at UHC and they are arguing the Guaranteed Issues Right doesn't apply since they are offering the new, no frills plans under a different subsidiary they own (they owned it prior to offering these plans, the plans did not come with the subsidiary - which I am sure you know but mentioning it in case others reading this don't).

In my opinion they are splitting hairs and he should be able to switch without having to pass medical underwriting since the plan is cheaper without the extras thus the extras, as he argues, aren't free, but then again the law/rules are likely in their favor. My guess is he will contact other agents if I am not successful in helping him. As he is a friend of a good friend I need to tread very carefully.

 

[rmhaire]

Client is 71 and fails medical underwriting for numerous reasons. Signed up at 65 in MS. Client originally wanted the community risk pool. When the client signed up only AARP/UHC has a community risk pool. Then AARP/UHC only had one G and that was with the "freebies". Client was eligible for F wanted G because no younger members would be joining over the years to keep the premiums lower in F. I explained originally and explained again that the increases were steeper the first years because they get a declining subsidy from UHC; UHC does the subsidy so the rates are more competitive when most people sign up so more people sign up thus the risk pool is larger (client complained about the rate increases since signed up; I pointed out it was less this year as no more subsidies). Due to the medical underwriting issue it is unlikely any plan will accept him without much higher rates than he is paying now in the plan he is in.

Client doesn't want the "extras". The only way out is the other G (due to community risk pool issue with him), complicated by failing medical underwriting for 3 cancers, one with no cure but a longer life span (indolent blood cancer last treated 13 years ago but has scans, etc. each year to check, other two are likely cured), heart disease just diagnosed last month (more tests mid Nov) that may need bypass surgery, etc. etc. (list of preexisting conditions is longer, includes a genetic defect that can cause health issues, long covid, neuropathy, pre diabetic, GI issues ) so any switch is likely not going to happen unless he is willing to pay much higher rates - if they even accept him.

Client was aware of these rules but thinks the Guaranteed Issues Right applies because the parent company actually isn't making the extras free since the identical plan without the extras is significantly less. As a result he thinks they violated the misleading information clause and so as a result he can switch without passing medical underwriting.

Friday I talked with several layers up the hierarchy at UHC and they are arguing the Guaranteed Issues Right doesn't apply since they are offering the new, no frills plans under a different subsidiary they own (they owned it prior to offering these plans, the plans did not come with the subsidiary - which I am sure you know but mentioning it in case others reading this don't).

In my opinion they are splitting hairs and he should be able to switch without having to pass medical underwriting since the plan is cheaper without the extras thus the extras, as he argues, aren't free, but then again the law/rules are likely in their favor. My guess is he will contact other agents if I am not successful in helping him. As he is a friend of a good friend I need to tread very carefully.

First of all I want to commend you on sticking with this one. Most agents would have tucked and run the other way.

And second, I want to apologize for barking at you with my first post. I totally misunderstood what you were talking about.

A couple of things I'd check is when was the last rate increase on his current plan and the same for the plan he wants to go to. Sometimes that can help explain the difference between the two.

How much is he paying now? And how much is the difference between the two plans?

As far as underwriting, nobody is going to take him with his heart situation. A potential bypass is a knockout with all carriers.

 

[LostDollar]

Client is 71 and fails medical underwriting for numerous reasons. Signed up at 65 in MS. Client originally wanted the community risk pool. When the client signed up only AARP/UHC has a community risk pool. Then AARP/UHC only had one G and that was with the "freebies". Client was eligible for F wanted G because no younger members would be joining over the years to keep the premiums lower in F. I explained originally and explained again that the increases were steeper the first years because they get a declining subsidy from UHC; UHC does the subsidy so the rates are more competitive when most people sign up so more people sign up thus the risk pool is larger (client complained about the rate increases since signed up; I pointed out it was less this year as no more subsidies). Due to the medical underwriting issue it is unlikely any plan will accept him without much higher rates than he is paying now in the plan he is in.

Client doesn't want the "extras". The only way out is the other G (due to community risk pool issue with him), complicated by failing medical underwriting for 3 cancers, one with no cure but a longer life span (indolent blood cancer last treated 13 years ago but has scans, etc. each year to check, other two are likely cured), heart disease just diagnosed last month (more tests mid Nov) that may need bypass surgery, etc. etc. (list of preexisting conditions is longer, includes a genetic defect that can cause health issues, long covid, neuropathy, pre diabetic, GI issues ) so any switch is likely not going to happen unless he is willing to pay much higher rates - if they even accept him.

Client was aware of these rules but thinks the Guaranteed Issues Right applies because the parent company actually isn't making the extras free since the identical plan without the extras is significantly less. As a result he thinks they violated the misleading information clause and so as a result he can switch without passing medical underwriting.

Friday I talked with several layers up the hierarchy at UHC and they are arguing the Guaranteed Issues Right doesn't apply since they are offering the new, no frills plans under a different subsidiary they own (they owned it prior to offering these plans, the plans did not come with the subsidiary - which I am sure you know but mentioning it in case others reading this don't).

In my opinion they are splitting hairs and he should be able to switch without having to pass medical underwriting since the plan is cheaper without the extras thus the extras, as he argues, aren't free, but then again the law/rules are likely in their favor. My guess is he will contact other agents if I am not successful in helping him. As he is a friend of a good friend I need to tread very carefully.

Caveat, not an agent.

I think UHC could make the case that rather than increasing price on the original plan, they provided additional, non-standardized benefits in a certain time frame on a certain Medigap plan as a loss leader to build market share. They are not required to offer those same supplementary additonal benefits for other Medigap plans issued by any of their subsidiaries.

I think you are going to have to tell your good friend that client refuses to recognize realities of the Medigap market which are totally beyond your control.