Guaranteed Issue Rights Question.

[LostDollar]

Ok, first thing, I had a bad link in my earlier post, I fixed that.

Second thing, I have assumed your client has not applied for part B.

So based on the earlier link, client has an 8 month SEP after coming off employer group plan to apply for part B. Getting part B then starts IEP for Medigap. In IEP for medigap, any medigap plan is available.

In GI situation only certain plans are allowed-per link which Somarco posted.

 

[goillini52]

Let me add to this one, because I am going in a circle on it.

Client is 67. Client is a spouse on a group plan and the group has less than 20 ee's.

Client needs to enroll in Part B. (She got A upon turning 65)

Does client pay the LEP or not?

No LEP..............

 

[LostDollar]

Let me add to this one, because I am going in a circle on it.

Client is 67. Client is a spouse on a group plan and the group has less than 20 ee's.

Client needs to enroll in Part B. (She got A upon turning 65)

Does client pay the LEP or not?

Vic...What's her Part B eff date? If its now, its open enrollment, not GI.

If its past 8 months, its GI.

(2 caveats: I only sell in TX. And I do these all the time, with a Part B eff date that starts the next month)

You have two issues going on there, one of which I was making an attempt to allude to in another thread by asking op a question which ran contrary to all other posts.

The first issue is what the group plan pays in relation to Medicare.

In the small group plans ( less than 20 emps), the plan pays secondary to Medicare.

But on the second issue, the penalty issue, client is a spouse of an active employee covered under a group plan so they are eligible for the SEP for part B. So what I'm saying is to the extent I understand it now, the group plan size has effects on Co-ordination of benefits, but does not affect the Medigap SEP provisions.

https://www.medicare.gov/sign-up-ch...parts-a-and-b/when-sign-up-parts-a-and-b.html

(And I'm confused - if you and Vic are talking about the same person we have some conflicting information.)

 

[kgmom219]

We are not talking about the same person

Thanks!

 

[LostDollar]

Vic,
I don't think you have a GI situation.

https://www.medicare.gov/supplement...gap/when-can-i-buy-medigap.html#collapse-2510

You can pick up on Somarco's thought and try it anyway and see what happens-just be prepared for rejection.

 

[vic120]

No LEP..............

Are you Sure I thought it would be LEP because group is less than 20 or am I missing something?

 

[LostDollar]

Are you Sure I thought it would be LEP because group is less than 20 or am I missing something?

See my notes to kgmom above, group size has bearing on coordination of benefits but not on part B SEP.

Situational difference:
Your client got Medicare A and B at 65, kgmom's client only got Part A at 65.

 

[kgmom219]

Are you Sure I thought it would be LEP because group is less than 20 or am I missing something?

Its a cluster.

I got 2 different answers when calling Medicare.

Its not addressed in Medicare and You.

BCBS punted with "I think they don't pay LEP"

Gollini (who I have a lot of respect for) said "No LEP"

I'll come back when she gets the Welcome letter and let you know.

I finally just emailed her and said "I think you are going to pay $134 for Part B. Worst case scenario is $160 (She's less than 2 years out from 65). But I can't get a straight answer, so please go apply and let's get started. Either way, you are still under $300/month which is significantly less than the current $1100."

 

[goillini52]

Are you Sure I thought it would be LEP because group is less than 20 or am I missing something?

There's no penalty because she's coming off her spouse's group coverage.

 

[somarco]

L564E waives the LEP and allows person coming off group to pick up Part B upon loss of group (but not COBRA) rather than having to wait until the GEP to enroll.

If the dependent/employee had B all along they need to prove continuous group coverage since age 65 to qualify for GI.

If insurable they can go through underwriting and buy any plan.