First 12 months going to supp. Question?

yeager · 08-21-2008, 01:21 PM

I am new to forum and am trying to get an answer on people leaving an MA plan and going back to Med Supp.

If someone has a MA HMO plan and within the first 12 months wants to get out, they have that right to go back to their pld plan. Problem is, the HMO plan they were on is not taking new members. SO that should allow them to go to any Medicare Supplement they want. Now I know with one company they can go back to plan A or F. My question is if they can answer no to questions on the app can they go to a G or E plan?

jdeasy · 08-21-2008, 02:31 PM

Quote:

Originally Posted by yeager

I am new to forum and am trying to get an answer on people leaving an MA plan and going back to Med Supp.

If someone has a MA HMO plan and within the first 12 months wants to get out, they have that right to go back to their pld plan. Problem is, the HMO plan they were on is not taking new members. SO that should allow them to go to any Medicare Supplement they want. Now I know with one company they can go back to plan A or F. My question is if they can answer no to questions on the app can they go to a G or E plan?

I don't believe that the HMO they were in has a choice of taking them back as long as they are still in business.

But, if they do, the person can sign up for any med sup offered in their State on a guaranteed issue basis.

yeager · 08-21-2008, 02:47 PM

Quote:

Originally Posted by jdeasy

I don't believe that the HMO they were in has a choice of taking them back as long as they are still in business.

But, if they do, the person can sign up for any med sup offered in their State on a guaranteed issue basis.

The HMO is not taking any new people plus it was suppose to be gone per Medicare in 09. Medicare is/was doing away with some cost plans. That was why these people went to the MA HMO. They were told in 09 the HMO they were on was going away, so they could stay on HMO for one more year or go ahead and switch to the new MA HMO. Well, Medicare has now told them you can keep the HMO through 09.

jdeasy · 08-21-2008, 02:59 PM

Quote:

Originally Posted by yeager

The HMO is not taking any new people plus it was suppose to be gone per Medicare in 09. Medicare is/was doing away with some cost plans. That was why these people went to the MA HMO. They were told in 09 the HMO they were on was going away, so they could stay on HMO for one more year or go ahead and switch to the new MA HMO. Well, Medicare has now told them you can keep the HMO through 09.

It doesn't matter what it is supposed to do, it maters what it is. If they are still business, CMS will force them to take the person back. Each case is different and there could be some mitigating factors, but, by rule, the HMO would have to take them back now.

If it goes out of business next year, they would have another GI period. If you have companies willing to take them on a GI basis now, it may be to their interest to go ahead and get in one.

wammy · 08-23-2008, 02:35 PM

He nailed it.

yeager · 08-23-2008, 05:30 PM

After several phone calls, one particular company will not take these people on GI. The HMO will not take them either. Going to call UW Monday and my guess is they will take these people.

On a related note, talked to one PDP company that will not take the people that have an HMO MAPD, if they went back to Medicare and a supp. Talked to a different company and they said they would take them w/ an SEP reasoning being SEP65. I find that very strange.

Frank Stastny · 08-23-2008, 05:42 PM

Quote:

Originally Posted by yeager

My question is if they can answer no to questions on the app can they go to a G or E plan?

If the person can answer no to the health questions on the application it doesn't matter what they have now. They can take any Med Supp Plan with any company that offers them in your state.

And, they can take, at least in Missouri, any PDP plan they want but probably have to wait until 11/15 to sign up for the PDP plan.

I'm not sure what you mean when you said, "Medicare is/was doing away with some cost plans." What is a "cost" plan?

If you are talking about Med Supp plans that is total new news to me. I only sell Med Supps, not any of the Advantage plans, they are not good for my clients and I have not heard that.

jdeasy · 08-23-2008, 07:21 PM

Quote:

Originally Posted by yeager

After several phone calls, one particular company will not take these people on GI. The HMO will not take them either. Going to call UW Monday and my guess is they will take these people.

On a related note, talked to one PDP company that will not take the people that have an HMO MAPD, if they went back to Medicare and a supp. Talked to a different company and they said they would take them w/ an SEP reasoning being SEP65. I find that very strange.

You are getting bad info somewhere. If they are in an MA HMO currently and it's their first time in an MA, they can leave that plan if they are within the first 12 months. They can go back to original medicare and since they are also leaving the MA HMO's drug coverage, they can sign up for any PDP available in their state. The Plan they were on has no choice in the matter of taking them back. If they want to go back to that plan and that plan won't allow it, contact CMS and they will cahnge their tune.

If thses folks don't want to go back to their original plan and are trying to use the first 12 months option as an escape from both plans, they will not be successful with that. If CMS provides their original plan with a waiver on these people, they could then sign with any med sup carrier in their State on a GI basis.

As Frank noted, if the health questions are not an issue, they could just go back to original medicare, get a PDP plan if they want one and then apply for any med sup plan available.

There seems to be more to this story than you are telling.

Frank Stastny · 08-23-2008, 09:30 PM

Quote:

Originally Posted by jdeasy

There seems to be more to this story than you are telling.

Those were my thoughts as I was typing my response.

He said he was new to the forum but I assumed that he was not new to insurance. However, as I thought about it he almost sounds like he got into the senior market to sell MA plans without knowing anything about Medicare, Medicare Supplement plans and how the whole senior insurance program works.

I really hope I'm wrong and he isn't "one of those".

Any rookie should know that if a person can answer no to the health questions on an application that any Med Supp policy from any company is available to them.

yeager · 08-24-2008, 05:55 PM

Not new to insurance or senior market. Been in senior market for 15 years. My dad been it for 35+ years.

The old plan will not take these people back. It is an HMO and Medicare told them everyone in it would have to get out of it in 2009. So they came up with a HMO MA and HMO MAPD. Since, Medicare has now changed and said they can keep the old HMO for one more year. The HMO is described as a "cost" plan. From what I have been told, there are only a handfull of these in the entire country. And Medicare is saying they are going to do away with all of these type of plans.

As far as the HMO MAPD people. Perscription Pathway after 4 different phone calls to them say they will not take these people if they were to go back to medicare and a supp. We feel that that is wrong but they are standing firm on their stance. Humana however will take them under SEP.

jdeasy · 08-24-2008, 06:57 PM

Quote:

Originally Posted by yeager

Not new to insurance or senior market. Been in senior market for 15 years. My dad been it for 35+ years.

The old plan will not take these people back. It is an HMO and Medicare told them everyone in it would have to get out of it in 2009. So they came up with a HMO MA and HMO MAPD. Since, Medicare has now changed and said they can keep the old HMO for one more year. The HMO is described as a "cost" plan. From what I have been told, there are only a handfull of these in the entire country. And Medicare is saying they are going to do away with all of these type of plans.

As far as the HMO MAPD people. Perscription Pathway after 4 different phone calls to them say they will not take these people if they were to go back to medicare and a supp. We feel that that is wrong but they are standing firm on their stance. Humana however will take them under SEP.

You need to take this up with CMS. The old plan has to take them back. They also can sign up with any PDP plan. Sometimes you have to get CMS involved to educaate the company marmamdons. Depending on what State you are in, the people could have even more protections that described here.

Anyway, you are taking what the plan says as the final answer. The plan is not the final arbiter. CMS is. I am a certified trainer for the MA and Part D plans. Yet, I still have to get CMS involved in some of the SEP situations because the companies do not know the rules. I recently had a situation with Wellcare where I had to go through 3 levels of management and 3 way call with that 3rd manager and CMS in order to get a simple SEP handled for a couple that were losing credible coverage. No matter how many time I told Wellcare and showed them the rules in writing, they wouldn't budge off their ignorance until CMS told them that I was right. The SEP was granted immediately and they even overnighted the membership card to the folks.

You seem to be at that checkmate. You can drop the issue and wait until AEP or you can get involved in the fight. This is where agents earn their stripes.