I have a lady 68, going through cancer treatments, I signed her up last year with UHC Advantage plan and she quickly hit the $3300.00 out of pocket. Her meds for her heart on top of that is $300.00 per Month.
If we had known about the cancer before signing her up on UHC and would have put her on the AARP "J" plan, she would have saved money, true or false?
Question is: Can she switch to the Medicare Supplement J plan?
I do not sell supplements, but guess I better start.
If she has had the MA plan for less than 12 months then yes you can switch her to a med supp as long as...
1. It was her first time enrolling in a MA plan and is within her 12 month enrollment and she came from a med supp.
or
2. She just signed up for medicare part B and this was her first time on a medicare plan.
If she has already hit the max out of pocket, I would probably leave her on the existing plan through the end of the year and write the med supp for a Jan 1 effective date. The cancer is not an issue for the AARP med supp, so you do not need GI. The real work will be in determining the PDP that best fits her needs...
This is her first MA plan, started 1/1/09. She was not on any plan before that. She has been on Medicare A & B since 2006. Yes, she has hit the out-of-pocket.
What is AARP GI.
I would say, if you get cancer, an Advantage plan is not the way to go.
This is her first MA plan, started 1/1/09. She was not on any plan before that. She has been on Medicare A & B since 2006. Yes, she has hit the out-of-pocket.
What is AARP GI.
I would say, if you get cancer, an Advantage plan is not the way to go.
I don't know what county you are talking about, so I picked Hillsborough to check the rates. In the instance of your plan's max out of pocket being at $3300 (Iowa's is $1950 for UHC Complete Plan I), your client would have saved money, depending on the PDP of course if was on the supplement. UHC's Medicare Supplement Plans D, F and J are all priced around $2000 annualized premium. Wait until this October when the details of the new MAPD come out, and the new rates for Med Supps for 2010. This past week I spent calling all of my clients and talking to them about the reform bills in Congress. I found that they are all very concerned about what is going to happen if anything changes. I suggest you learn what you can between now and AEP about Med Supps just in case they make more sense than MA for 2010. There are plenty of resources on this site, just ask.
As for your question about this particular client, she is best where she is. Her max out of pocket has been met, she would be spending much more out of pocket with premiums for the Med Supp and PDP than she will with the MAPD the rest of this year. Just try to figure out what changes she will need for next year. Show her how you are trying to find the best plan for her situation and her budget and you will have a client for life.
BTW, her cancer won't be a factor in her picking up an AARP Med Supp if the underwriting is the same in FL as it is in IA. There is only one health question on the application and it refers to End Stage Renal Disease. Very few companies out there are this lenient on their underwriting, so you are in a good place to be able to help her.
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Tim Sipma
Sipma & Associates
515-537-4459 tim.sipma@gmail.com
Last edited by timsip : 08-08-2009 at 04:12 PM.
Reason: thought
This is her first MA plan, started 1/1/09. She was not on any plan before that. She has been on Medicare A & B since 2006. Yes, she has hit the out-of-pocket.
What is AARP GI.
I would say, if you get cancer, an Advantage plan is not the way to go.
I second that request. Please explain the AARP GI.
I second that request. Please explain the AARP GI.
I am just guessing here, but I don't think "AARP GI" is the correct terminology, but since I didn't say it, I am just guessing. I don't know if other states have different underwriting requirements, I would assume not, but I know in Iowa, there is only one medical question relating to ESRD; if you have ESRD you can't get the policy, but at the same time Medicaid has a program for those that have ESRD that either covers, or helps cover their medical expenses.
I am just guessing here, but I don't think "AARP GI" is the correct terminology, but since I didn't say it, I am just guessing.
I believe you are correct. I have never heard of an area where AARP is genuinely GI. GI is no health questions and the company must issue the policy even if the person has ESRD and is in the hospital. An agent can write a policy on that person.
Under certain circumstances every Med Supp policy can be GI. I do believe that there are some states, I think Michigan is an example, where BC&BS may not have any health questions on their app. I'm sure someone from there will set the record straight.
It is important in the senior market to know what Open Enrollment and Guaranteed Issue are and the difference between them.
SAI does know the difference and was just generalizing. I knew what he meant.
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I believe you are correct. I have never heard of an area where AARP is genuinely GI. GI is no health questions and the company must issue the policy even if the person has ESRD and is in the hospital. An agent can write a policy on that person.
Under certain circumstances every Med Supp policy can be GI. I do believe that there are some states, I think Michigan is an example, where BC&BS may not have any health questions on their app. I'm sure someone from there will set the record straight.
It is important in the senior market to know what Open Enrollment and Guaranteed Issue are and the difference between them.
SAI does know the difference and was just generalizing. I knew what he meant.
I am sure that is what he was referring to, but I wanted to make sure to clarify for those that are new to the market so they didn't go out and tell clients the wrong thing. As we discussed the other day on the phone, the internet is a great tool for information, but you have to be able to know what is good and what is bad, and what is mis-worded, such as in this instance. I don't think anything malicious was intended, simply a choice of words that can mean something different to other people.
I will say this, you all have answered my questions most adequately, I thank you all very much.
This lady has become a great client. I felt bad at first for advising her to do a MA plan, but we didn't know the shots and some treatments were not fully covered. I would think if she was done with the worst part of the treatments, that now it would be cheaper to have the MA plan. The only big cost now will be the heart pills at $300.00 per month, but they are going to try to find some kind of assistance for that.
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