What to Do, Cancer and Med Supp?

[Tx249]

I have a 53 yo female becomes eligible for medicare on December 1st. Now on Texas Risk Pool as her cobra ran out and didn't qualify for medicare yet.

I believe she should be GI to start with, but after she picks a plan, may not be able to make changes from year to year. Is that correct?

I'm thinking looking for a good plan D and prescription drug. Any suggestions and who to go thru, and what about the drug plans and cancer drugs? Currently the biggest expense is a treatment called hercepton every three weeks. It's actually a drug similar to chemo, but not.

 

[Frank Stastny]

I have a 53 yo female becomes eligible for medicare on December 1st. Now on Texas Risk Pool as her cobra ran out and didn't qualify for medicare yet.

I believe she should be GI to start with, but after she picks a plan, may not be able to make changes from year to year. Is that correct?

I'm thinking looking for a good plan D and prescription drug. Any suggestions and who to go thru, and what about the drug plans and cancer drugs? Currently the biggest expense is a treatment called hercepton every three weeks. It's actually a drug similar to chemo, but not.

In Missouri (not sure about Texas) as soon as her Medicare Part A and B go into effect she would be eligible for Open Enrollment That is not the same as Guaranteed Issue. Guaranteed Issue has a whole different set of circumstances.

In my opinion you have made the best choice for her by recommending a Plan D. Ask someone here from Texas which company has the best rates for a Plan D. It will be helpful if you give them the zip code.

In Texas once she picks a plan and the Open Enrollment period has expired she will probably have to keep that plan. The only way out of it will be if she has gone at least two years without any treatment for cancer.

I believe the cancer treatment will be covered but it will be best for you to check with the underwriting dept of the company you use.

I have no recommendations on a PDP plan. Get the drugs and look them up and see what you can come up with.

 

[AJAX]

You might want to check with your state's insurance department, by web or phone. To see what types of plans are available, being that the client is under 65 years old.

I am not familiar with your state, but, in Florida most Med Supp's do NOT insure under 65 yr olds.

Your client can definitely get into a Medicare Advantage plan with Rx coverage, as long as she has her part B effective/active. You would want a plan with a low Maximum-Out-of-Pocket limit on the MAPD plan, this would protect her from catastrophic medical expenses. And she would probably need a PPO plan, so that she can see specialists more easily.

Medicare.gov
plug in zipcode
meds
it will show you either MAPD comparisons/PDP comparisons

The bigger companies like UHC, WellCare, or BCBS usually have the largest formularies

 

[timsip]

I have a 53 yo female becomes eligible for medicare on December 1st. Now on Texas Risk Pool as her cobra ran out and didn't qualify for medicare yet.

I believe she should be GI to start with, but after she picks a plan, may not be able to make changes from year to year. Is that correct?

I'm thinking looking for a good plan D and prescription drug. Any suggestions and who to go thru, and what about the drug plans and cancer drugs? Currently the biggest expense is a treatment called hercepton every three weeks. It's actually a drug similar to chemo, but not.

UHC/AARP has only one medical question on their application, but I don't know what their rates are in Texas; so if she doesn't like the plan she originally signs up for, AARP is one avenue to explore after OE expires.

 

[GreenSky]

UHC/AARP has only one medical question on their application, but I don't know what their rates are in Texas; so if she doesn't like the plan she originally signs up for, AARP is one avenue to explore after OE expires.

Tim:

The poster said she'll be getting Medicare in Dec. There are NO questions if supplements in Texas are available for under age 65. I don't believe UHC/AARP offers supps to anyone under 65 except during her IOEP.

She has one choice and let's hope she chooses a company that won't raise her rates quickly.

Rick

 

[timsip]

That is not the same as Guaranteed Issue. Guaranteed Issue has a whole different set of circumstances.

I have read you state this in a couple different threads, and I could not figure out what you were trying to say, so I looked it up. My mentor in this business always said that if you don't know something, look down and read.

The difference is that during Open Enrollment, some pre-existing conditions could have a six month waiting period, but after that period, they are covered. Medicare does a very good job of explaining it:

While the insurance company can't make you wait for your coverage to start, it may be able to make you wait for coverage of a pre-existing condition. A pre-existing condition is a health problem you have before the date a new insurance policy starts. In some cases, the Medigap insurance company can refuse to cover your out-of-pocket costs for these pre-existing health problems for up to 6 months. This is called a "pre-existing condition waiting period." Coverage for a pre-existing condition can only be excluded in a Medigap policy if the condition was treated or diagnosed within 6 months before the date the coverage starts under the Medigap policy. (Remember, for Medicare-covered services, Original Medicare will still cover the condition, even if the Medigap policy won't cover your out-of-pocket costs.)

(p.16)

It is also important to note that the only time a pre-existing coverage waiting period can be applied is when the prospect has not had any health coverage the preceding six months prior to Part A & B eligibility. If they are coming off of other health coverage, they are in Guaranteed Issue Rights.

Even if you have a pre-existing condition, if you buy a Medigap policy during your Medigap open enrollment period and if you recently had certain kinds of health coverage called "creditable coverage," it is possible to avoid or shorten waiting periods for pre-existing conditions. Prior creditable coverage is generally any other health coverage you recently had before applying for a Medigap policy. If you have had at least 6 months of prior creditable coverage, the Medigap insurance company can't make you wait before it covers your pre-existing conditions.

(p.17)

The likelihood of a prospect being in Open Enrollment and not being covered by Guaranteed Issue Rights is slim.

This is the only thing that keeps Open Enrollment out of the definition of Guaranteed Issue Rights. I think we are splitting hairs a little when corrections are made, but it is important to know the difference when talking to prospects. I have not seen a prospect that was in Open Enrollment and not protected under the Guaranteed Issue Rights.

I hope this clears up any confusion.

 

[Frank Stastny]

Tim,

It may be "splitting hairs", however, especially for agents new to the senior market, I think it is important that they know the difference and not call or assume that Open Enrollment is the same as Guaranteed Issue.

The instances where GI can be used will vary greatly from state to state. Open Enrollment is available for everyone who turns 65 nation wide providing they have paid SS for forty quarters.

Open Enrollment can only be used once in many states. Under certain circumstances it can be used twice Missouri. Guaranteed Issue can be used as many times as the person qualifies.

Medicare makes a distinction between Guaranteed Issue and Open Enrollment, agents should know the difference and do the same.

There was no confusion on my part. Good job on the research.

 

[timsip]

Tim,

It may be "splitting hairs", however, especially for agents new to the senior market, I think it is important that they know the difference and not call or assume that Open Enrollment is the same as Guaranteed Issue.

The instances where GI can be used will vary greatly from state to state. Open Enrollment is available for everyone who turns 65 nation wide providing they have paid SS for forty quarters.

Open Enrollment can only be used once in many states. Under certain circumstances it can be used twice Missouri. Guaranteed Issue can be used as many times as the person qualifies.

Medicare makes a distinction between Guaranteed Issue and Open Enrollment, agents should know the difference and do the same.

There was no confusion on my part. Good job on the research.

May not have been any confusion on your part, but as you said, for new agents to this market, there could easily be a lot of confusion on their part without the explanation.

 

[senior-advisor-indiana]

Every state is different too. In Indiana we do not have to worry about pre x conditions with med supp policies.

 

[jsanchez001]

Hello TX249,
You will want to check with the carrier to see what their requirements are. Here in NJ, you can get a med sup under 65 from certain companies, Mutual of Omaha, Genworth, BC/BS, but not from AARP. But if you are under 55, then some carriers will not offer it, even under Open Enrollment. And only a plan C is available to them.
You MUST check with the underwriters