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

yogooglethis

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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 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..


The trial right is for the first time in an MA plan. Might be a way around it based on why Humana switched her? To the letter of the rule she is SOL.

Might be worth pursuing with CMS though.

This lady might have an out on the "You leave a Medicare Advantage Plan......because the company hasn't followed the rules, or it mislead you."

Again, why the switch on the Humana plans?
 
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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..


So I have a question based on the trial right mentioned. In the Choosing A Medigap Policy it says this

"(Trial Right) You joined a
Medicare Advantage Plan or
Programs of All-inclusive Care for
the Elderly (PACE) when you were
first eligible for Medicare Part A
at 65, and within the first year of
joining, you decide you want to
switch to Original Medicare."

I have seen posts from others stating that this applies no matter when they first join a MA plan, but the above says at age 65. Does anyone have any experience with this. I have never used the trial right so I am unclear.
 
There is another trial right for people that left a med sup to join an MA plan. The age on that doesn't matter.

If a person didn't do anything at age 65 and then at age 69 or 70 or whatever decied to get an MA plan that person would not have a trail right if they wanted to get a med sup.

Go to pages 22 and 23 of 2013 Choosing a Medigap Policy handbook and it lists all the GI and trial rights.


So I have a question based on the trial right mentioned. In the Choosing A Medigap Policy it says this

"(Trial Right) You joined a
Medicare Advantage Plan or
Programs of All-inclusive Care for
the Elderly (PACE) when you were
first eligible for Medicare Part A
at 65, and within the first year of
joining, you decide you want to
switch to Original Medicare."

I have seen posts from others stating that this applies no matter when they first join a MA plan, but the above says at age 65. Does anyone have any experience with this. I have never used the trial right so I am unclear.
 
There is another trial right for people that left a med sup to join an MA plan. The age on that doesn't matter.

If a person didn't do anything at age 65 and then at age 69 or 70 or whatever decied to get an MA plan that person would not have a trail right if they wanted to get a med sup.

Go to pages 22 and 23 of 2013 Choosing a Medigap Policy handbook and it lists all the GI and trial rights.

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.
 
It seems that you are right on that. I've never used that but I have seen it posted here that situation would be GI. Not according to the book they don't.



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 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..

Answer the question yes first time in MA. Humana.
They switched her to a snp for her best interests.
 
The trial right is for the first time in an MA plan. Might be a way around it based on why Humana switched her? To the letter of the rule she is SOL.

Might be worth pursuing with CMS though.

This lady might have an out on the "You leave a Medicare Advantage Plan......because the company hasn't followed the rules, or it mislead you."

Again, why the switch on the Humana plans?



Actuallly the switch was suitable because the Humana SNP plan is for diabetics and covers some of the meds in the gap. I don't know the whole story why they just didn't start her out on that plan in the first place.
 
Actuallly the switch was suitable because the Humana SNP plan is for diabetics and covers some of the meds in the gap. I don't know the whole story why they just didn't start her out on that plan in the first place.

You could probably get her by with what houcoogster said. This may not be as difficult as we are making it?
 
There is another trial right for people that left a med sup to join an MA plan. The age on that doesn't matter.

If a person didn't do anything at age 65 and then at age 69 or 70 or whatever decied to get an MA plan that person would not have a trail right if they wanted to get a med sup.

Go to pages 22 and 23 of 2013 Choosing a Medigap Policy handbook and it lists all the GI and trial rights.




In Florida I know there is a 12 month GI for Med supp and 12 month trial for those who enrolled in an MA plan when they T65.What's not spelled out is are they referring to enrolling in a MA plan in IEP window and using up your one time IEP code to be eligible for the SEP 65 code that's used to disenroll from a MAPD plan or to enroll in a PDP plan.



I didn't ask what month the second MA enrollment took place but if she T65 2/1/13 and she was switched to second MA 3/1/13 does this make her eligible? I am guessing probably not since it's the second MA enrollment within the IEP window and was done with a SEP chronic election code

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You could probably get her by with what houcoogster said. This may not be as difficult as we are making it?




Hopefully it is that easy but i am very concerned with this one because she is going through a lot of medical care right now.
 
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