Who's Right?

[Jessica Durphy]

Look, it's no secret that I'm fairly new, but I have learned a lot! I'm still learning... but this case really confuses me! I'm hoping that someone will give me a direct answer and help me before I have a meeting with this fella today.

In PA, I have a guy who is 68, he was sold a MAPD when he turned 65 by an agent that lives a few hours away. He's not happy with it at all, and has tried on several occasions to get a hold of his prior agent. He called me, because he was referred to me by a friend, and told me of his situation. About 7 years ago, before he turned 65, he got a type of Lymphoma cancer... he said that he's never had a stitch of chemo, no shots, no nothing... it's the same as it's been for 7 years. He has no complications from this at all.. Once a year, the dr. will take blood work just to make sure that he's still doing the same or better. And the results have not changed in 7 years. He has no other issues, no heart problems, diabetes, cholesterol, high blood pressure... nothing!

His wife is healthy as a horse, she has absolutely no issues whatsoever!

My question is: for the husband, I'd like to try and get him into a supplement, because he's never been in a Supplement, will he have an option to get into one with out any questions asked? Because of the OEP? They have one time where they can change or go back to.... See I was told that he could, then I was told that he couldn't do that because he would lose his drug coverage.... and I wouldn't be able to get him into a PDP, now. I just want to do what's right for this fella and not make his life worse!

For his wife, she wants to go to a supplement as well, but because of what I was told about the drug plan, I'm fearful to switch her... is that true? Can I sell someone who has a MAPD a Supplement with a PDP now? is that possible? IF they have NEVER had a supplement before?

 

[Newby]

If they go back to original Medicare they can take a PDP plan which is considered like for like to an MAPD.
Taking the Med Sup is optional and won't affect it at all.

 

[Jessica Durphy]

If they go back to original Medicare they can take a PDP plan which is considered like for like to an MAPD.
Taking the Med Sup is optional and won't affect it at all.

even if they've never had a Supplement before? (do you think it would be a waste of time to try it for the gentleman?)

 

[G.Gordon]

They will both have to pass underwriting since they have been on the MA for three years; they have no guarantee issue provisions this far down the road. That provision ended at the 366th day. AARP might be his only option.

As far as PDP they both have the option to disenroll from the MAPD and take any PDP that is available in thier area.

Good luck.

 

[jdeasy]

Look, it's no secret that I'm fairly new, but I have learned a lot! I'm still learning... but this case really confuses me! I'm hoping that someone will give me a direct answer and help me before I have a meeting with this fella today.

In PA, I have a guy who is 68, he was sold a MAPD when he turned 65 by an agent that lives a few hours away. He's not happy with it at all, and has tried on several occasions to get a hold of his prior agent. He called me, because he was referred to me by a friend, and told me of his situation. About 7 years ago, before he turned 65, he got a type of Lymphoma cancer... he said that he's never had a stitch of chemo, no shots, no nothing... it's the same as it's been for 7 years. He has no complications from this at all.. Once a year, the dr. will take blood work just to make sure that he's still doing the same or better. And the results have not changed in 7 years. He has no other issues, no heart problems, diabetes, cholesterol, high blood pressure... nothing!

His wife is healthy as a horse, she has absolutely no issues whatsoever!

My question is: for the husband, I'd like to try and get him into a supplement, because he's never been in a Supplement, will he have an option to get into one with out any questions asked? Because of the OEP? They have one time where they can change or go back to.... See I was told that he could, then I was told that he couldn't do that because he would lose his drug coverage.... and I wouldn't be able to get him into a PDP, now. I just want to do what's right for this fella and not make his life worse!

For his wife, she wants to go to a supplement as well, but because of what I was told about the drug plan, I'm fearful to switch her... is that true? Can I sell someone who has a MAPD a Supplement with a PDP now? is that possible? IF they have NEVER had a supplement before?

You have two issues here. The first is whether or not he can get out of his MAPD yet still keep a PDP. That one is easy, yes he can. He has until March 31 to disenroll from the MAPD and return to original Medicare. He not only can pick up a PDP, he must get one. He came into OEP with a PDP, he must leave OEP with one.

The second issue is getting a med sup. Unless Pa. has some rule granting him him a GI that is over and above federal law, he wouldn't have a GI for a med sup. Talk to your underwriters about his condition and see what they say. Someone else mentioned AARP. That could be an option if underwriting at a good company says they won't take him.

 

[Tom Highway]

Thinking outside the box here, but they could drop the MAPD plan and get a PDP and original medicare effective April 1. Then, you could write them in one of the new supps effective June 1.

Some of the new med supps have guaranteed issue, right?

This would come with a HUGE caveat and understanding on the part of the family that they would only have original Medicare and a pdp for two months. They would still be covered, but their cost share would be higher, and the risk is on them.

How bout that?

 

[G.Gordon]

Or enroll in AARP for two months for a band-aid then switch to MOO plan N under GI... to piggy back off Tom.

 

[Jessica Durphy]

Great guys.... I really appreciate your help!!!!

 

[Fisher]

What is 'OEP'?

 

[Jessica Durphy]

What is 'OEP'?

Open Enrollment Period... January 1st -March 31st it's a time for Seniors to change their plans to another "like" plan.

For instance, Medicare Advantage Precription Drug Plan (MAPD) to another MAPD. Or a Supplement with a PDP.. is considered a "like" plan... because it's got the coverage plus a drug plan.. like a MAPD.