Does this Prospect Qualify for GI

steveadlman

Guru
100+ Post Club
I have a prospect that lost his group retiree coverage on 12/31/2016. He is a retiree of Michelin and they cancelled their group retiree plan and have asked their retirees to go through AON. My prospect signed up for a MAPD and now regrets that decision. I do not see where he is entitled to GI since it has been longer than 63 days since his group retiree plan was cancelled. He needs GI because of health issues. Can he get GI if he wants to go back to Original Medicare and get a Supplement?
 
If this is the first time he enrolled into MA and he dropped a sup to do it he can get his previous sup back GI

Now I believe some carriers will allow into their Supp GI, I did have AARP pay me GI on this situation and the woman was perfectly healthy I answered all the medical questions, I argued that CMS only allows GI if she went back to original sup to no avail. UHC takes this as GI situation regardless

I know some others do as well I just don't know which
 
I have a prospect that lost his group retiree coverage on 12/31/2016. He is a retiree of Michelin and they cancelled their group retiree plan and have asked their retirees to go through AON. My prospect signed up for a MAPD and now regrets that decision. I do not see where he is entitled to GI since it has been longer than 63 days since his group retiree plan was cancelled. He needs GI because of health issues. Can he get GI if he wants to go back to Original Medicare and get a Supplement?

Yes he can go with Plan F with any med Sup company he wants during his 1st year on Med Advantage if he never had a Sup before. Tell him to use a real agent this time and don't fall for AON.
 
Yes he can go with Plan F with any med Sup company he wants during his 1st year on Med Advantage if he never had a Sup before. Tell him to use a real agent this time and don't fall for AON.

But can he? The Trial Right states if they join a MA when they were first eligible for Part A at 65 and within the first year of joining you decide to switch back to original Medicare.

Do we know if this person just turned 65 when they enrolled in the MA plan?
 
But can he? The Trial Right states if they join a MA when they were first eligible for Part A at 65 and within the first year of joining you decide to switch back to original Medicare.

Do we know if this person just turned 65 when they enrolled in the MA plan?

If he was new to part B when he left the group he gets the same as turning 65. He preserved his "turning 65" status.

If he already had Part B longer than a year then he is screwed.
 
If he was new to part B when he left the group he gets the same as turning 65. He preserved his "turning 65" status.

If he already had Part B longer than a year then he is screwed.

I only point it out because I had a carrier stand firm on the age 65 wording. Even though the person was within one year of Part B starting. Over the years I have come to find carriers tend to interpret the GI rules differently.

Several years ago I had MoO flat out say no on a person who moved from another state and lost his MA. The letter from the MA carrier didn't specify the reason for the loss of coverage. It didn't matter that we provided other documentation proving he moved.

And to the other extreme, UHC is very liberal with those rules.
 
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