Client is 58 and enrolled in Part A based on disability. A few years ago she also had Part B but dropped it because she concluded that she was already covered through her husband's plan at work.
Now the husband is retiring and going on Medicare so her coverage through his group is ending. She has multiple major health issues.
Has she lost her right to guaranteed issue for a med supp because she played the "Part B first time enrollment " card once already, or does she have guaranteed issue because she maintained creditable coverage and is losing it.
Guidance appreciated here. Thanks
Winter
------------------------------------ Stop the madness. We are going broke.
I see that as two separate GI situations and opportunities. Losing credible coverage should allow GI.
The underwriters at Mutual of Omaha are who I call for clarification on this kind of stuff. If I knew Frank's number I would call him instead
Chuck, I hate to have to bring this up again (I have posted numerous times about this) but the word is "creditable", NOT "credible".... and the rules about creditable coverage vary depending on what type of policy one is considering.
To my knowledge, creditable coverage will allow you protection for pre-ex within certain guidelines, depending on your state regulations, while GI is protection against ALL pre-ex. I think the earlier post from Winter is correct... she has lost her GI protection, but as long as she has had no break over 63 days in coverage, and the policy is "creditable", then a Med Sup MAY be issued without pre-ex, but with the time limit credits according to state allowances (6mos/12mos, etc).
Here is where I am uncertain: The big difference between these issues is that I think the pre-ex exclusion applies to the specific condition, but she still will have to answer the health questions, whereas with GI, no health questions need be answered. IOW, she may be rated if the policy has a rating structure. Check me on this.
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Chuck, I hate to have to bring this up again (I have posted numerous times about this) but the word is "creditable", NOT "credible".... and the rules about creditable coverage vary depending on what type of policy one is considering.
But you are a credible guy for making sure that they know the difference. Man, can you imagine if they went thru life not knowing, what would people be saying behind their backs>...? Bless you.
Chuck, I hate to have to bring this up again (I have posted numerous times about this) but the word is "creditable", NOT "credible".... and the rules about creditable coverage vary depending on what type of policy one is considering.
To my knowledge, creditable coverage will allow you protection for pre-ex within certain guidelines, depending on your state regulations, while GI is protection against ALL pre-ex. I think the earlier post from Winter is correct... she has lost her GI protection, but as long as she has had no break over 63 days in coverage, and the policy is "creditable", then a Med Sup MAY be issued without pre-ex, but with the time limit credits according to state allowances (6mos/12mos, etc).
Here is where I am uncertain: The big difference between these issues is that I think the pre-ex exclusion applies to the specific condition, but she still will have to answer the health questions, whereas with GI, no health questions need be answered. IOW, she may be rated if the policy has a rating structure. Check me on this.
You are correct if you are talking putting someone into an MA. I don't believe that's the case for a med sup. It may be in certain State, though. I recently had a situation where a person was on medicare and medicaid and had been since she first got medicare. She lost her medicaid as of Sept. 1, 2008 because of an increase in income.
She is 81 years old now and has never been without creditable coverage. I was instructed by CMS that she had no GI for a med sup except for the original 6 month period when she first got part B. They did tell me that Ky "might" offer her a GI in this situation. I spoke with 3 different people in the Ky DOI and each told me that she had no additional GI period available under Ky law.
I could have been misinformed by CMS and the Ky DOI, but, that's how it was laid out to me.
You are correct if you are talking putting someone into an MA. I don't believe that's the case for a med sup. It may be in certain State, though. I recently had a situation where a person was on medicare and medicaid and had been since she first got medicare. She lost her medicaid as of Sept. 1, 2008 because of an increase in income.
She is 81 years old now and has never been without creditable coverage. I was instructed by CMS that she had no GI for a med sup except for the original 6 month period when she first got part B. They did tell me that Ky "might" offer her a GI in this situation. I spoke with 3 different people in the Ky DOI and each told me that she had no additional GI period available under Ky law.
I could have been misinformed by CMS and the Ky DOI, but, that's how it was laid out to me.
NO... this does NOT apply to MAs at all! There are NO HEALTH QUESTIONS for a MA application except for one... and that is an exclusion for ESRD.
NO... this does NOT apply to MAs at all! There are NO HEALTH QUESTIONS for a MA application except for one... and that is an exclusion for ESRD.
You seem to have gotten off track. We are not talking about the health questions of an MA. We are talking about the GI period for a med sup.
The 63 day period you mentioned is for an SEP to join an MA or a PDP plan. There is no such animal for a med sup. A person has one GI period for a med sup unless your State has different rules. The 63 day stuff has nothing to do with med sups.
You seem to have gotten off track. We are not talking about the health questions of an MA. We are talking about the GI period for a med sup.
The 63 day period you mentioned is for an SEP to join an MA or a PDP plan. There is no such animal for a med sup. A person has one GI period for a med sup unless your State has different rules. The 63 day stuff has nothing to do with med sups.
You need to break out your "Choosing a Medigap Policy" booklet ( that is required to be left with every Med Sup client), and turn to page 18. The very first GI situation states: "You can apply up to 60 calendar days before the date your health care coverage will end. You must apply no later than 63 calendar days after your health care coverage ends." This goes on for every other issue right for GI, all the way to #7.
Off track? I think not.
Yes, the Open Enrollment Period is one time 6 months following enrollment in Part B. Winter said his client used that privelege up... now it is the pre-ex question, not GI.
To my knowledge, creditable coverage will allow you protection for pre-ex within certain guidelines, depending on your state regulations, while GI is protection against ALL pre-ex.
I am trying to understand what is being said here. GI doesnt always provide protection against pre-ex. A carrier can impose pre-ex exclusions even during open enrollment for 3-6 months. Guaranteed issue when transitioning from creditable coverage may protect you from pre-ex exclusions if state law provides this protection.
Are we sort of on the same page here or not? Slap me around if not.
I believe she would fall under a SEP and be eligible for GI. Personally, I would throw the noodle against the wall and see if it sticks. Be honest and let her know that you are getting conflicting information and give it a whirl. The company is ultimately the one making the decision. If it comes back no, you can always fall back to an MA plan. I'd say do it quick- within her 63 days.
Good luck!
If it comes back no, you can always fall back to an MA plan. I'd say do it quick- within her 63 days.
Good luck!
In addition to the MA fallback, you can always get someone on to an AARP med supp plan if they do not have end stage renal. I would have to refer it out though because I gave up my AARP appointment at the end of the last enrollment period and have no interest in selling their products again. But it is an option for the client.
I checked up on state law again today and I think I am all set. She will need to step lively though because she needs to obviously get the part B enrollment before I can do the supp enrollment.
You need to break out your "Choosing a Medigap Policy" booklet ( that is required to be left with every Med Sup client), and turn to page 18. The very first GI situation states: "You can apply up to 60 calendar days before the date your health care coverage will end. You must apply no later than 63 calendar days after your health care coverage ends." This goes on for every other issue right for GI, all the way to #7.
Off track? I think not.
Yes, the Open Enrollment Period is one time 6 months following enrollment in Part B. Winter said his client used that privelege up... now it is the pre-ex question, not GI.
Actually, situation number 1 is for a person leaving an MA plan. The situation that Winter is asking about is #2. His client is leaving an employer plan. It plainly states; "Note: In this situation, state laws may vary."
I believe she would fall under a SEP and be eligible for GI. Personally, I would throw the noodle against the wall and see if it sticks. Be honest and let her know that you are getting conflicting information and give it a whirl. The company is ultimately the one making the decision. If it comes back no, you can always fall back to an MA plan. I'd say do it quick- within her 63 days.
Good luck!
Actually, situation number 1 is for a person leaving an MA plan. The situation that Winter is asking about is #2. His client is leaving an employer plan. It plainly states; "Note: In this situation, state laws may vary."
I didn't say issue #1 applied to Winter's situation, merely responding to your comment that the 63 day limit for creditable insurance did not apply to Med Sups. I pointed out that it applied to every GI protection in the book.
Guaranteed issue question
...but you are correct, I should know better.
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