SEP Permanent Move MAPD

[Chazm]

How would a guaranteed issue med supp be done in this (not the OP but in a GI med supp) situation?

UHC's producer handbook and guide doesn't say it's GI. Only Medicare.gov.
And on the application there's no where to put "client moved out of service area".

 

[traceyemoon]

TwoCents, good call. On the other hand, he has not moved out of his plan's service area, so still will not apply in this case.

 

[sman]

How would a guaranteed issue med supp be done in this (not the OP but in a GI med supp) situation?

UHC's producer handbook and guide doesn't say it's GI. Only Medicare.gov.
And on the application there's no where to put "client moved out of service area".

Go to page 22 of the 2017 Choosing a Medigap Policy guide (link below)

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwj0l8TA5fDVAhWEOCYKHdJDCEkQFghIMAA&url=https%3A%2F%2Fwww.medicare.gov%2FPubs%2Fpdf%2F02110-Medicare-Medigap.guide.pdf&usg=AFQjCNFdkZz_FAXYg_C9OZB_HUESsyQMbA

The very first box discusses moving out of the service area of a MAPD and what the rights are. It very clearly states the following:

Medigap Plan A, B, C, F, K, or L that’s sold in your state by any insurance company. You only have this right if you switch to Original Medicare rather than join another Medicare Advantage Plan.

As for UHC, question 3B on their Georgia app asks about them having a GI right and to provide the letter that they'd get from the MAPD insurer. Also, in their enrollment kit (again, I am speaking only for Georgia) it states the following under the Guaranteed Acceptance section (page 17 in the Georgia enrollment kit):

You are replacing a Medicare Advantage plan, a Program of All-Inclusive Care for the Elderly (PACE), or a Medicare Select plan
for any of the following reasons:
- The plan stopped coverage in your area,
- The plan notified you it will be stopping coverage in your area; or
- You moved out of the plan’s service area.

 

[Chazm]

Go to page 22 of the 2017 Choosing a Medigap Policy guide (link below)

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwj0l8TA5fDVAhWEOCYKHdJDCEkQFghIMAA&url=https%3A%2F%2Fwww.medicare.gov%2FPubs%2Fpdf%2F02110-Medicare-Medigap.guide.pdf&usg=AFQjCNFdkZz_FAXYg_C9OZB_HUESsyQMbA

The very first box discusses moving out of the service area of a MAPD and what the rights are. It very clearly states the following:

Medigap Plan A, B, C, F, K, or L that’s sold in your state by any insurance company. You only have this right if you switch to Original Medicare rather than join another Medicare Advantage Plan.

As for UHC, question 3B on their Georgia app asks about them having a GI right and to provide the letter that they'd get from the MAPD insurer. Also, in their enrollment kit (again, I am speaking only for Georgia) it states the following under the Guaranteed Acceptance section (page 17 in the Georgia enrollment kit):

You are replacing a Medicare Advantage plan, a Program of All-Inclusive Care for the Elderly (PACE), or a Medicare Select plan
for any of the following reasons:
- The plan stopped coverage in your area,
- The plan notified you it will be stopping coverage in your area; or
- You moved out of the plan’s service area.

Thanks for the info. Since I rarely, if ever run across this and I was given bad info a few months ago, I called my FMO. She confirmed that it is GI but it didn't say it in the FL UHC handbook. But she told me to do the replacement form And under "other" put in "moved out of service area". And when they get that letter that shows they moved it needs to be sent to UHC.

I learn something new everyday and I've realized not to take one persons word for it. Check around. Thanks.

 

[sman]

Thanks for the info. Since I rarely, if ever run across this and I was given bad info a few months ago, I called my FMO. She confirmed that it is GI but it didn't say it in the FL UHC handbook. But she told me to do the replacement form And under "other" put in "moved out of service area". And when they get that letter that shows they moved it needs to be sent to UHC.

I learn something new everyday and I've realized not to take one persons word for it. Check around. Thanks.

That's probably one of the best things about this forum. The ability to ask questions and get answers.

 

[DS4]

I live in an area with no MA's. People with MA's move here and I write GI med supp with SEP Mov plus PDP.

 

[WCMason]

I recently tried to get a GI med supp app through for someone who moved to a new county but in same service area. The carrier researched the old and new addresses and declined the app because the beneficiary's former plan was available in the new county, so there was no involuntary loss of coverage. The client was approved by CMS to change to a different MA plan.

 

[kstein]

I'm going through this same thing now. Client has cancer and needs treatments starting now and into September.

I was hoping to GI onto Anthem or AARP (in MO) as they tend to be extra liberal on GI situations but not here.

However, the client can switch from a PPO to an HMO/POS plan that has a 2400 max vs 6000 with the PPO so that might benefit him. I always forget a person can change MAPD even if their current plan isn't terminating .

I think AARP may also accept him at level 2 rates so that might be a good way to go (Plan N is about $200mo) and then enroll him into a PDP plan.

Thanks everyone for the insights. Sometimes different supplemental carriers view GI differently so it's good to check a few specifically.

 

[TwoCents]

I'm going through this same thing now. Client has cancer and needs treatments starting now and into September.

I was hoping to GI onto Anthem or AARP (in MO) as they tend to be extra liberal on GI situations but not here.

However, the client can switch from a PPO to an HMO/POS plan that has a 2400 max vs 6000 with the PPO so that might benefit him. I always forget a person can change MAPD even if their current plan isn't terminating .

I think AARP may also accept him at level 2 rates so that might be a good way to go (Plan N is about $200mo) and then enroll him into a PDP plan.

Thanks everyone for the insights. Sometimes different supplemental carriers view GI differently so it's good to check a few specifically.

Well, keep in mind that if the person's MA is still available after a move that the only plans that they should be able to switch to would have to be new to them based on the move. In other words if the plan they wanted to switch to was available at the old address, then it's a no go to do a switch.

 

[WCMason]

Well, keep in mind that if the person's MA is still available after a move that the only plans that they should be able to switch to would have to be new to them based on the move. In other words if the plan they wanted to switch to was available at the old address, then it's a no go to do a switch.

This is not correct. If there are one or more plans available in the new county that were not available in the county they moved from the beneficiary has an SEP to choose any plan available in that county, whether or not that same plan was available in the county they moved from. They are not limited to the new ones that weren't available at their previous address. Just made an SEP change last month for someone who moved to an adjacent county. The plan he moved to was available in the county he moved from.