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Reply to ESRD MAPD Termination & Med Supp Question     
Old 12-11-2014, 09:30 AM   #1
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ESRD MAPD Termination & Med Supp Question ESRD MAPD Termination & Med Supp Question
If a mb is on an MAPD that leaves the service area, but is on ESRD, are they still able to be a guaranteed issue on a Med supp policy when the MAPD leaves?
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Old 12-11-2014, 09:34 AM   #2
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ESRD MAPD Termination & Med Supp Question Re: ESRD MAPD Termination & Med Supp Question
Sure, why wouldn't they be able to qualify for a Med supp guarantee issue? The ESRD question pertains to Medicare Advantage plans; not supplements. Unless I am reading the question incorrectly.
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Old 12-11-2014, 10:51 AM   #3
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ESRD MAPD Termination & Med Supp Question
Originally Posted by medicareguru View Post
Sure, why wouldn't they be able to qualify for a Med supp guarantee issue? The ESRD question pertains to Medicare Advantage plans; not supplements. Unless I am reading the question incorrectly.
Unless the beneficiary is under 65, at least in CA.

Rick
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Old 12-11-2014, 11:35 AM   #4
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ESRD MAPD Termination & Med Supp Question Re: ESRD MAPD Termination & Med Supp Question
Good resource:

http://www.medicare.gov/Pubs/pdf/10128.pdf

Also, if you have End-Stage Renal Disease (ESRD) and are enrolled in a Medicare Advantage Plan (like an HMO or PPO) that stops being offered in your area, you have a one-time right to join another Medicare Advantage Plan if one is available in your area.
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Old 12-11-2014, 12:07 PM   #5
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ESRD MAPD Termination & Med Supp Question Re: ESRD MAPD Termination & Med Supp Question
yeah, but who would want to be on an MAPD if they have ESRD?
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Old 12-11-2014, 01:35 PM   #6
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ESRD MAPD Termination & Med Supp Question Re: ESRD MAPD Termination & Med Supp Question
Originally Posted by medicareguru View Post
yeah, but who would want to be on an MAPD if they have ESRD?
Someone that might not qualify for a med supp?

An out of pocket limit of $3,400 isn't the worst thing in the world for zero premium.

Rick
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Old 12-11-2014, 03:04 PM   #7
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ESRD MAPD Termination & Med Supp Question Re: ESRD MAPD Termination & Med Supp Question
I am assuming you are speaking about California?
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Old 12-11-2014, 03:25 PM   #8
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ESRD MAPD Termination & Med Supp Question Re: ESRD MAPD Termination & Med Supp Question
Originally Posted by medicareguru View Post
I am assuming you are speaking about California?
I am. But even a 6,350 limit is better than no limit with Medicare only. The "trick" is to get the MA before ESRD. Otherwise it's SOL.

Of course, if the person can get a supplement that would be the best option.

Rick

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Old 09-06-2017, 07:20 PM   #9
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ESRD MAPD Termination & Med Supp Question Re: ESRD MAPD Termination & Med Supp Question
I had a California resident with ESRD who is turning 65 referred to me by a friend and while Anthem and UHC won't accept him for a Med Supplement there are other companies (Mutual of Omaha, Humana and a couple of others) who consider him to be within his Open Enrollment rights.

I called each of the companies and confirmed this with Agent services before making a recommendation to the referral.

I submitted the application to Mutual this afternoon with his ESRD noted in the 'Notes to Underwriting' section, I will follow up here once it is through Underwriting (either way).

This is my first ESRD case so, while surprised, it was good to see that he has options-he has been on group benefits for many years and his employer was going to take him off the group when he turned 65 whether it was compliant or not.
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Old 09-06-2017, 07:24 PM   #10
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ESRD MAPD Termination & Med Supp Question Re: ESRD MAPD Termination & Med Supp Question
Originally Posted by FLM2 View Post
I had a California resident with ESRD who is turning 65 referred to me by a friend and while Anthem and UHC won't accept him for a Med Supplement there are other companies (Mutual of Omaha, Humana and a couple of others) who consider him to be within his Open Enrollment rights.

I called each of the companies and confirmed this with Agent services before making a recommendation to the referral.

I submitted the application to Mutual this afternoon with his ESRD noted in the 'Notes to Underwriting' section, I will follow up here once it is through Underwriting (either way).

This is my first ESRD case so, while surprised, it was good to see that he has options-he has been on group benefits for many years and his employer was going to take him off the group when he turned 65 whether it was compliant or not.
T65 has no medical questions so ESRD is not a problem. It's open enrollment. ESRD is only an exclusion in CA for under 65 just getting Medicare.

Why was this even an issue?

Rick
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