Insurance Agent Forum

[scottfree]

I have a question about a client that has been on disability and on a MA plan for the past 2 years. She turned 65 in May of this year. I believe she may be better off on a med sup. Has she missed her guaranteed issue window to get on a med sup plan? I am thinking that she needed to apply in October for a Nov. 1 start date to get issued. I am thinking this is correct. I am not sure if this is what she wants but don’t want to bring it up if it is not an option. She has a ton of meds and would not qualify with underwriting.

I was thinking that you had one year to try out an MA plans once you turn 65 but I think that it is just one year when you first try out these plans and not from when you turn 65.


Another note (don't think it makes a difference) the Unicare plan she is on is being discontinued, Unicare is still in the area but they are pulling the SecurityChoice Enhanced Plus but has other crappy plans.
Any input?

[Joe Moore]

Originally Posted by scottfree

I have a question about a client that has been on disability and on a MA plan for the past 2 years. She turned 65 in May of this year. I believe she may be better off on a med sup. Has she missed her guaranteed issue window to get on a med sup plan? I am thinking that she needed to apply in October for a Nov. 1 start date to get issued. I am thinking this is correct. I am not sure if this is what she wants but don’t want to bring it up if it is not an option.

I was thinking that you had one year to try out an MA plans once you turn 65 but I think that it is just one year when you first try out these plans and not from when you turn 65.



Any input?

From Medicare & You:

What Do You Need to Know If You Want to Buy a Medigap Policy? (continued) The best time to buy a Medigap policy is during the 6-month ■■period that begins on the first day of the month in which you are both age 65 or older and enrolled in Part B. (Some states have additional open enrollment periods.) After this initial enrollment period, your option to buy a Medigap policy may be limited

From this definition, it seems she would be age 65 on June 1, not May 1. Six months from June 1 would be November 30. It appears to me you should have the month of November to enroll her Guarantee Issue in a Medicare Supplement.

[Dave020]

It would be six months from May 1 for her if her birthday were anytime in the month of May. It's always the first of the month of your birth.

She had May, June, July, Aug, Sept, Oct to GI on a supplement. Nov is 7th month, no longer GI.

[Joe Moore]

Originally Posted by Dave020

It would be six months from May 1 for her if her birthday were anytime in the month of May. It's always the first of the month of your birth.

She had May, June, July, Aug, Sept, Oct to GI on a supplement. Nov is 7th month, no longer GI.

But, she was not age 65 May 1. Look at what Medicare says: "you are both age 65 or older and enrolled in Part B."

The actual 6 months would be 6 months after her May birthday, sometime in November.

[GreenSky]

Since her MA plan is being discontinued, she is eligible for any Medicare Supplement on a GI basis.

Rick

[Dave020]

Joe - as I have always understood it, Medicare uses the first of the month of your age change to 65 as the start date. When someone goes on Medicare at age 65, Part A & B are effective 1st of the month of birth, regardless of which day in that month is the person's birthday. Even 31 May is a May 1 start date for A & B.

So, in practice, most people are on A & B and perhaps a supplement before they actually turn 65, for however many days until their real birthday.
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Originally Posted by GreenSky

Since her MA plan is being discontinued, she is eligible for any Medicare Supplement on a GI basis.

Rick

I defer to your expertise on this Rick. So anytime a person on an MA plan wants to drop it they are GI for a supplement?

[jdeasy]

[quote=Dave020;111581]Joe - as I have always understood it, Medicare uses the first of the month of your age change to 65 as the start date. When someone goes on Medicare at age 65, Part A & B are effective 1st of the month of birth, regardless of which day in that month is the person's birthday. Even 31 May is a May 1 start date for A & B.

So, in practice, most people are on A & B and perhaps a supplement before they actually turn 65, for however many days until their real birthday.
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I believe you to be correct on the interpretation. In fact, if one's 65 birthday is on the 1st of the month, they get part B on the 1st of the previous month. I have a client who's 65th birthday was Aug 1, 2008. The effective date of his Medicare A and B is 7-1-08.
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Originally Posted by GreenSky

Since her MA plan is being discontinued, she is eligible for any Medicare Supplement on a GI basis.

Rick

Are you sure about that? The rule is "You are in a Medicare Advantage Plan, and your plan is leaving the Medicare Program or stops giving care in your area, or you move out of the plan's service area."

According to what he said, the plan is not leaving or stopping giving care, they are changing the plan.

I hope you are correct. I have a lot of clients in Advantra here where they are changing the plan. They are making a different one available and they say that means that the people do not qulify for a med sup GI under the above rule. I have spoken to the Ky DOI and they indicate the same. They are supposedly checking this out.

[theinuranceguy]

If someones Birthday is in May they have until Nov to pick up a Supp on GI basis.

If a MA plan is discontinued in a county, it is also a GI basis for a supp. IE: When Pacificare was bought out by UHC I had many clients switch to a GI Supp

But AARP will allow GI two years after someone turns 65.

So you always have that.

[GreenSky]

Originally Posted by jdeasy

Are you sure about that? The rule is "You are in a Medicare Advantage Plan, and your plan is leaving the Medicare Program or stops giving care in your area, or you move out of the plan's service area."

Yes, I'm sure.

Example: Anthem Blue Cross has 2 almost identical MAPD plans for 2008. The only difference in these PPO plans was the deductible.

They are dropping one plan for 2009. Even Anthem agrees this triggers a GI situation for a med supp.

Rick

[Dave020]

Rick - I don't think Scott was saying that the MA plan is being discontinued, only that he wants to move client to a supplement. So, in that case there is no GI on the supplement, correct?

Ramiz - why does the client get November? Is it different for T65 already on A & B?

I have three on my desk right now for supplements. The earliest birthday is the 15th of the month and all three indicate that A & B are effective the 1st of that respective month. That would count as the first month of the 6-month window, right?

[Joe Moore]

Originally Posted by Dave020

Joe - as I have always understood it, Medicare uses the first of the month of your age change to 65 as the start date. When someone goes on Medicare at age 65, Part A & B are effective 1st of the month of birth, regardless of which day in that month is the person's birthday. Even 31 May is a May 1 start date for A & B.

So, in practice, most people are on A & B and perhaps a supplement before they actually turn 65, for however many days until their real birthday.

I understand the normal practice but from the way this is worded, May 1 she was not really 65. You could make a hell of an argument out of this and maybe win the argument.

Did any of us ever think we would have to become half-lawyer to survive or understand the insurance business?

[Dave020]

Seems to be only with senior products. Never have these issues with IFP or small group. Too much regulation and too many rules.

Sup - 6-month GI window from eligibility Part B date

MAPD - 7-month window 3 before, month of and 3 after

[Joe Moore]

Originally Posted by scottfree

Another note (don't think it makes a difference) the Unicare plan she is on is being discontinued, Unicare is still in the area but they are pulling the SecurityChoice Enhanced Plus but has other crappy plans.
Any input?

I did not see this addition. Yes, this should completely make this a GI Supplement.

[Dave020]

Didn't see it either. Rick is right, as usual (you ARE the man!)

(now that I said that, where's my beer LOL?)

[theinuranceguy]

Originally Posted by Dave020

Ramiz - why does the client get November? Is it different for T65 already on A & B?

You have six months before and six months after your birthday 65th birthday to pick up a supp on a GI basis.

So technically its a 13 month window.

[GreenSky]

Originally Posted by Dave020

Didn't see it either. Rick is right, as usual (you ARE the man!)

(now that I said that, where's my beer LOL?)

I was the one that was right. Where the hell is my Guinness?

Rick