Special Election Periods Help

[DonP]

I have a client in a similar situation - sort of. His employer has 6 employees, so he was required to go on Medicare when he turned 65. Medicare is primary, and the employer plan (which he gets free) is secondary. He has an MA only plan, and the employer plan gets the bill for copays and provides creditable drug coverage (similar to someone who has Tricare for Life and an MA only plan). When he retires he can use LEC to enroll in a PDP. UHC tells me that he will also have GI for a med supp based on losing employer coverage, as long as he applies within 63 days.

I did read that he has a 63 day GI period from the date of loss of coverage no matter when he took out part A and B . I was always under the assumption you had a 6 month Iep window for med sup from the time you signed up for part B . I didn’t know if you have part A and B and group coverage and you retire you have a 63 day Gi period . But as another poster said you won’t get paid doing that in most states if he needs the Gi.

 

[somarco]

many times you think you've got it all figured out, and then you go back to read the right info.

When you ask enough of the right questions, you will eventually discover how confused your prospect really is. I try not to get tripped up by the prospect but occasionally they will come back at the last minute and say "I just thought of this . . . does it make a difference?"

It often does . . .

Some carriers, presumably all, state if you are losing creditable coverage and that coverage PAYS AFTER (secondary) to Medicare, and you lose coverage INVOLUNTARILY, then you may qualify for a Medigap on a GI basis.

In addition to paying near $0 commission to the agent in most states, carriers are getting tough about GI apps. Some ask for documentation (proof) before they will approve the application.

Assume nothing . . .

 

[alphawave2k]

Prospect needs to login to his MyMedicare account, click the NAME and scroll down to MY PLANS.

Look for A & B effective dates
Look under OTHER INSURANCE and see what shows up, also the coverage start date.

Other insurance could show the EGH or MA but should not show both.

I did ask him to do this, and fyi, it showed he has a Medicare Advantage Plan (HumanaChoice PPO), and under Other Insurance it states United Healthcare with a coverage start date of 5/1/2023 which is the EGH plan.

So now, I'm wondering how was this possible? And does the order as written above signify his Medicare is primary, and his EGH plan doesn't come into play as far as covering any costs?

 

[somarco]

If MA is primary and EGH secondary the EGH is probably paying nothing except Part B expenses.

If the Medigap carrier follows the rules and asks for documentation, GI for Medigap goes out the window. You can still try but if the GI section says anything about the lost coverage paying AFTER Medicare someone will have to fudge the application and hope nobody checks the fact.

You also have the INVOLUNTARY loss of coverage issue, but there are SOME states that say voluntary or involuntary loss of coverage.

If he can pass underwriting give that a shot. I don't see a path to GI with this scenario.

 

[tikibarrister]

I came to this thread for Hillary and Kamala jokes and am disappointed.

 

[somarco]

I came to this thread for Hillary and Kamala jokes and am disappointed.

Those are in the 1,000 post club section.

You aren't missing anything. Boring . . .

 

[goillini52]

I came to this thread for Hillary and Kamala jokes and am disappointed.

 

[goillini52]

 

[goillini52]

 

[rmhaire]

I came to this thread for Hillary and Kamala jokes and am disappointed.

Plenty in the Political Humor thread. We're putting them on there as fast as we can.