Med Supp and Group Health

[jemelton]

im afraid that it is nowhere to be found...I called Medicare and they told me they can have as many other insurances as they want but only one med supp

 

[Josh]

Theoretically speaking he can have all kinds of other insurance as noted in the CMS reference guide in my other posts. But, a group plan and a medigap plan cannot be in force at the same time because both work in conjuction with Medicare not with each other.

I hate to be rude, but are you just making this up as you go along?

He can have a Medigap policy, Medicare, and a group policy. Depending on the size of the group Medicare would pay primary, the gap would fill it in, and he could use his group plan for RX, other doctors, or any of the gaps after the Medigap policy depending on which one he went with.

You don't know what you're talking about and you have no business advising others when you don't understand how this works in the first place.




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[somarco]

How does group and Medigap pay together if a person has their A and B? They don't.

Actually, it is possible since Medigap plans don't have Rx benefits.

The specific authority on this is buried in the vast amount of material avilable through CMS and the Insurance Code.

Are you running for public office?

You haven't told me his age or when his part B started.

What does that have to do with the topic at hand?

 

[Frank Stastny]

I hate to be rude, but are you just making this up as you go along?

He can have a Medigap policy, Medicare, and a group policy. Depending on the size of the group Medicare would pay primary, the gap would fill it in, and he could use his group plan for RX, other doctors, or any of the gaps after the Medigap policy depending on which one he went with.

You don't know what you're talking about and you have no business advising others when you don't understand how this works in the first place.

You are correct!

The individual can have a Med Supp and retain their group health plan. Prior to Part D I sold a lot of Med Supp Plans to people who had group plans. They kept their group plans for the drug benefit. For all other medical expenses they used Medicare and their Med Supp.

In general there would be no reason for them to use their group plan for medical expenses because Medicare and their Med Supp is going to pay all qualified medical expenses. The coverage is almost always superior to a group plan.

I don't see that the group plan is under any obligation to refund any premiums unless they were notified in writing and continued to collect premiums after the cancellation date.

As one of the previous posters stated, see if advancing the effective date of the Med Supp will help him out.

 

[Josh]

Wasn't it you that said it's been a few years since you've done Medicare? I'd be careful what you say and who you're saying it to. I'm not getting into a hissing match over this one. Waste of time.

I was a carrier rep that did compliance training for agents on Medicare Advantage plans for about four years. Things have changed a bit, but not that much.

You have no source for the claim you're making and when the OP called Medicare they said the exact same thing I did.

If you've been doing this for more than a year you should be keenly aware of the fact that retiree benefits can go with anything unless the retiree plan has a PDP or an MA contract built into it. If that's the case, they could still have a Medigap policy, but it wouldn't pay anything.

I gave you an out when I asked for a source and you've not supplied one. There is absolutely no reason why the client having a Medigap policy and retiree benefits is "against Medicare rules" and shame on you for publicly leading someone astray.

The OP isn't the one I think anyone should be concerned about, it's the clients that have agents that can't even admit when they don't have any idea of what they're talking about, but insist that they're right. This isn't a "hissing match", it's you giving misinformation and having that pointed out.


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Update: looks like our friend lisaann has left the building.

 

[windi]

You are correct!

The individual can have a Med Supp and retain their group health plan. Prior to Part D I sold a lot of Med Supp Plans to people who had group plans. They kept their group plans for the drug benefit. For all other medical expenses they used Medicare and their Med Supp.

In general there would be no reason for them to use their group plan for medical expenses because Medicare and their Med Supp is going to pay all qualified medical expenses. The coverage is almost always superior to a group plan.

I don't see that the group plan is under any obligation to refund any premiums unless they were notified in writing and continued to collect premiums after the cancellation date.

As one of the previous posters stated, see if advancing the effective date of the Med Supp will help him out.

learn something new every day.... isn't that the old saying?

i had no idea. Got a question though, why WOULD a person go with their group coverage and then get a medigap? I understand the group coverage pays prescriptions, but can't they get that through Part D for less? What instances did you sell a medigap to a client who then kept their group?

 

[Josh]

learn something new every day.... isn't that the old saying?

i had no idea. Got a question though, why WOULD a person go with their group coverage and then get a medigap? I understand the group coverage pays prescriptions, but can't they get that through Part D for less? What instances did you sell a medigap to a client who then kept their group?

Almost never.

Part D is usually cheaper, but it also has holes in the coverage that most group plans don't (unless they're employer part D plans).

 

[SportsNut]

learn something new every day.... isn't that the old saying?

i had no idea. Got a question though, why WOULD a person go with their group coverage and then get a medigap? I understand the group coverage pays prescriptions, but can't they get that through Part D for less? What instances did you sell a medigap to a client who then kept their group?

The old adage, if SOME is good, then MORE is better.

Keep in mind in this thread the case study is in a group health plan of less than 20 employees, so one could have a Medigap which would be primary coverage, and if he kept the grp health it would likely turn out to be expensive Rx coverage, aka secondary.

But, if the person was in a grp health plan of 20 or more employees, then the Grp health plan would be primary and Medicare would be secondary. This is a cluster mess since for all practical purposes M'care will pay nothing as secondary so either be on grp health or Medicare but not both if in a grp of 20 or more.

Who pays first

 

[CABenefits]

He's out of luck, no refund. It was his responsibility to notify the carrier of other coverage. While he could use the group health as mentioned for part d it very rarely makes sense. What he could look into is a group retiree plan that has strong part d coverage such as seniors choice. They have a stand alone drug plan that has no coverage gap. I would only propose it if needs better drug coverage than part d's in the open market or if his business wants to pretax premiums

Mike

 

[DS4]

What instances did you sell a medigap to a client who then kept their group?

Never.
If you do the math , it is better premium wise for the client to cx the employer plan and enroll on a med supp & Part D.
Coverage gap? With the premium savings, you can finance your way through the coverage gap.