- 6,481
Is there a CMS document for that, or has that just been your experience in practice. (Not trying to insult, just want to know.)
Guaranteed Issue Rights Question.
- Thread starter vic120
- Start date
Is there a CMS document for that, or has that just been your experience in practice. (Not trying to insult, just want to know.)
- 197
Not sure where this is in writing with CMS but I can add that it is accurate as I had a client recently report the same thing.
- Thread starter
- #23
Ahh, but if it were the working spouse than it would be LEP?
If I understand this correct it makes sense
- 6,481
I was stirring potatoes and thinking about the posts in the thread and my experiences with cobra. I was allowed to do something with cobra which made no sense to me but I think it came from the large group principle/requirement that everybody in the plan, regardless of age or whether they were employee or spouse, had to be treated equally.
I think your dissenting vote at medicare was probably thinking small group, spouse, equal eligibility rules dont apply, spouse gets LEP.
Now, whether that Medicare person was giving you a personal opinion or an informed, experienced Medicare answer based on a CMS document we have not yet been able to identify--I don't know. I will be most interested to hear the results of your client's application.
Edit:
I'd go with Special Enrollment Period at the bottom of P23.
Last edited:
Which doesn't differentiate for less than 20 ee groups.
BTW...its the Part B SEP form. You take it to your employer and they complete it. The problem is if you changed employers or a company went out of business and blah, blah, blah.
CMS-L564E(5)
- 29,526
- 6,481
Yes. And that is consistent with the CMS.gov page I referenced in an earlier post.
As you know I have been roundly chastized and criticized for overthinking things when i was going through processes of looking at things like HDF plans and asking questions about plans like plan J. This is an instance where I am reversing that attitude and saying we are overthinking things.
The thread has gotten a bit confused because we have two issues going on. The one involving your client is about an LEP for Medicare part B when part B was not taken at T65 age due to the presence of an employer plan. The only criteria issue here is the dropping of the employer plan and the time gap between that event and the part B app.
The "less than 20 -- 20 or more employee break" was created by (or for-not sure which) CMS to deal with a Medigap guaranteed issue concern. It has no bearing on whether an employee should or should not be assessed a late enrollment penalty in relation to the acquisition of part B.
----------
Thank you for that answer.
somarco's post was quite confusing to me and I have been studying on it. What I finally see is that I asked the wrong question-my uncertainty relates to the GI portion of his comments rather than the use of the form.
I think I can find CMS documentation about the use of the form if I look hard enough.
What is creating confusion for me is the practical application of GI by Medigap carriers. The rules state that GI is only applicable in the instance of small (less than 20 emp) groups. Somarco's experience -- and maybe yours too? -- is that in practice, the carriers don't worry about the employer group size when processing a GI application.
It appears we have two separate, but often intertwined, issues in this thread.
GI for Medigap is one issue.
LEP penalties and when a person can start Part B are another issue.
Sometimes the late enrollment (with or without penalty) comes into play when someone is looking to enroll in a Medigap plan after turning 65. The applicant must have both A & B in place before they can have a Medigap plan.
Medicare rules can be confusing and sometimes do not appear to mesh with the way carriers handle "late" Medigap apps. Add states that have their own rules and it is difficult for outsiders to follow the discussion.
I think all of us get confused from time to time. I know I do. Dealing with this every day you would think we have encountered all the possibilities. Yet new situations come up from time to time that don't seem to fit the mold.
Last year I wrote more GI cases than normal thanks to having Aetna available and paying more than $15 one time for GI business. Since they cut their compensation down to pennies I am once again out of the GI business but will be referring as much as I can to UHC.
GI for Medigap is one issue.
LEP penalties and when a person can start Part B are another issue.
Sometimes the late enrollment (with or without penalty) comes into play when someone is looking to enroll in a Medigap plan after turning 65. The applicant must have both A & B in place before they can have a Medigap plan.
Medicare rules can be confusing and sometimes do not appear to mesh with the way carriers handle "late" Medigap apps. Add states that have their own rules and it is difficult for outsiders to follow the discussion.
I think all of us get confused from time to time. I know I do. Dealing with this every day you would think we have encountered all the possibilities. Yet new situations come up from time to time that don't seem to fit the mold.
Last year I wrote more GI cases than normal thanks to having Aetna available and paying more than $15 one time for GI business. Since they cut their compensation down to pennies I am once again out of the GI business but will be referring as much as I can to UHC.
