State Health Plan with MAPD?

[crs6633]

I have a client who's wife is a retired teacher. Her plan offered by the state is a PPO supplement with a 5900 MOOP, 1500 Deductible and 70/30 after ded. The trick is, it's a supplement, not MA. She is an insulin dependent diabetic so a Medigap is out.
The question is have is: If I place her in an MAPD will the State Health Plan act as a supplement to it? My gut tells me no, but that's only because I'm positive that a Medigap plan doesn't work with MA.

 

[somarco]

I don't know which state, but the GA SHBP is indeed a self funded MAPD. Supposedly TN has a supplement but I get conflicting information.

Your state SHBP may have a caveat that prohibits entry/re-entry if you reject their plan initially or later.

CMS rules prohibit an agent from selling a Medigap as a "supplement" to a commercial MAPD and I imagine the same would hold for any other MAPD, corporate or government

 

[axeman462]

I have a similar situation I am investigating right now. A lady I came across has an Aetna State Funded Health Plan from NJ. She currently also has a local MAPD HMO.

She tells me the Aetna retirement plan would act as a supplement to the local MAPD, and doesn't want to cancel the retirement plan because she "earned it" after "working for 32 years for the state of NJ" and its "totally free" since NJ pays for it..

anyway, that being said, she does use the Aetna retirement plan because the network has no doctors here in Florida, which is why she got the local MAPD HMO. But, the locala HMO dont have very many doctors either that she wants to see, and since she also goes to NJ often, I'm thinking a medsupp would be a good choice for her.

But, I am concerned about how this other insurance would interfere with it. Anyone know about these Aetna retirement plans from NJ? She worked for the state, in Social Services.

 

[somarco]

@axeman462 if HR in NJ is anything like GA good luck in finding someone who really understands the plan. Even if you do find such a person they probably won't talk to you since you are not a plan beneficiary.

When my wife worked for the school system here and was getting ready to retire I had to feed questions to her and she would relay them to someone in HR. She actually got more useful information from the agency that "handled" the group.