Does this Lady Qualify for a GI Med Supp Under 12 Month Trial Period?

[WCMason]

There is this "(Trial Right) You dropped a
Medigap policy to join a Medicare
Advantage Plan (or to switch to a
Medicare SELECT policy) for the
first time, you have been in the
plan less than a year, and you want
to switch back. "

This only applies if they dropped a medigap plan to go to an MA. What if someone delays Part B til 70, gets an MA and within the first year want to go to a Supp. I have seen people post that they get GI on this, but nowhere in the guide does it say that.

I've had this happen in my early days. 72 y.o. guy had taken B unnecessarily early while covered by wife's EGHP. Put him in an MA at her retirement. Told him he had a trial right, unaware that there was an exception to the first time, first year GI trial right rules. He called me in the middle of the 12th month, December, wanting to exercise the trial right and get a med supp. I wrote the app, enrolled him in a PDP. On Dec. 31 I was informed by the med supp carrier that the trial right does not apply, as he did not enroll in the MA at 65 and did not drop a med supp to try it. With me at an airport waiting to board a flight and him at a hospital where his wife had just died, we conference called the PDP to withdraw that app so his MA could be restored. Got it done as flight was boarding. Big rookie mistake barely averted a big problem. One day later he'd have been out of the MA, unable to qualify for a med supp, only having A, B, and D for all of the next year.

Worked out ok. As it turned out it was his wife who had pushed for him to change to the med supp as she had gotten at retirement. He'd been content with the MA but went along to please her. It did take about six weeks for the MA plan to reinstate. Maybe my most stressful case. Still don't get why the exception to the trial right.

 

[yogooglethis]

I have a prospect in Fl who signed up for a Humana MA 2/1/13 when she turned 65 but Humana switched her to their SNP MA for Chronic illness a few months later so this is second MA enrollment since she turned 65.

She want s a Med supp now from UHC and on the application it ask " was this your first time in an MA plan " When I answer that question no does that disqualify her for both the 12 month SEP Trial period to go back to the Original G Medicare and also for the GI for the Medicare supplement..

I found out today that this lady still has her GI for the Med Supp 12 month " Trial right " available according to the UHC Med supp helpline but I still cant determine if her SEP 65 ( for those who enroll in MA for the first time using IEP at age 65 ) to disenroll from her MAPD or to enroll in a PDP is still available.The PHD at UHC will not advise whether an election code is valid or not.

Reading the election code info makes it seem like it's possibly still available. Anybody know for sure if it is? I know sometimes election sometimes will work when technically they shouldn't have but I want to be positive it's valid.

First Time MA
Member
(Age-In)
Enrolled in Medicare
Advantage upon eligibility
(age 65)
* The consumer is not
required to submit proof of
entitlement. The plan is
required to verify Medicare
entitlement. This SEP only
applies to consumers who
enroll in an MA plan using
their IEP at the time of their
65th birthday.
 Member Attestation
 Medicare Entitlement
Letter*
 Copy of Medicare ID
Card or SSA Award
Letter
Begins month enrolled in
MA for first time
Ends 12 months after
effective date
First day of the month
following receipt of
disenrollment request.
1 Election*
*Enroll into PDP if
coming from MA-PD, or
Disenroll into Original
Medicare
Code: SEP
Reason: SEP 65

 

[G.Gordon]

You'd be well served calling Medicare. If she can't get out of the pdp she can't move no matter. Technically she is not in her 12 mo trial since this is her second mapd plan. I have seen supp carriers interpret it as still gi and others stick to the hard line rules the law spells out. Good luck.

 

[PamTurner]

I'm struggling with this same question right now.

Have a client that enrolled in an MAPD (PPO), EFF AUG 1st (T65).

Too many increases on copays, and they are not covering one of her drugs anymore.

She wants to try an MAPD HMO now.

Even if she switches plans, she is still in her first year of the medicare advantage program, or "Part C." It seems like the 12 month trial is for "Medicare Advantage" in general, not just one plan. It really doesn't clarify, as far as I can see, does it?

Seems like she should be able to still exercise her trial up to a year, on more than one plan. She wants to try an HMO, and see if it will work for her needs, but wants peace of mind knowing she would have the option to go with Medigap before next August.

Does anyone have experience with this? If not I guess I'll have to call Medicare.

 

[G.Gordon]

I do. Her plan switch will be the end of her trial right. Her first decision to join a MAPD is over, she will then be in her second decision to do so.

You will find the rare company that will still give her the trial right GI, but they won't be the main line companies. I have UNL that let me pull one of these cases some time ago, been a while. The big dogs go by the letter of the rule now days.