Not according to UHC
Lost Part B, Got It Back in July. Do They Get Another OE for Supps?
- Thread starter TN_agent
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Not according to UHC
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- #12
She is on full extra help. She has a year round SEP for PDP or MAPD at any point to change so not an issue if it is denied, she is only on original Medicare +PDP now.
As far as her Part B status before, I have no idea. I asked her about it, her only answer was "I don't know what happened, I thought I had it I was on my ex-husband's insurance for a while, I was supposed to be signed up when I got out of jail, I just don't know", etc. So, maybe she is clueless or maybe she is being cagey. No computer or anything like that, I am not walking through setting up a my SSA with her.
I just don't want to get into trouble with my carriers. Maybe I should just tell her I can't help her or tell her she has to go through underwriting?
I think we are making this more complex than needed and I'm not a guru in this area by any stretch of the imagination.
Part A is automatic. Part B is optional. So, back in 04 did she have part B or not? Can we call medicare to check?
If not, then write her ASAP because she's good to go. If she did. Then MA her all day long.
Part A is automatic. Part B is optional. So, back in 04 did she have part B or not? Can we call medicare to check?
If not, then write her ASAP because she's good to go. If she did. Then MA her all day long.
- 289
Sorry, I missed "she's full extra help now", and followed your lead on Med Supp. So not sure why a Med Supp? It's rare to see a full dual on a Med Supp....just me, but I ain't no Guru, no Sir!
Not sure what you mean here, but I do understand not wanting to get your nuts caught in a vice.
I don't always offer my 2 cents here...but read a lot 'cause there are lot of smart folks here....a gold nugget is bound to wash through!
- Thread starter
- #15
Sorry, I missed "she's full extra help now", and followed your lead on Med Supp. So not sure why a Med Supp? It's rare to see a full dual on a Med Supp....just me, but I ain't no Guru, no Sir!
Not sure what you mean here, but I do understand not wanting to get your nuts caught in a vice.
I don't always offer my 2 cents here...but read a lot 'cause there are lot of smart folks here....a gold nugget is bound to wash through!
I don't know how to multquote, the setting up a mySSA was another poster suggesting that was how to figure out if another Part B date existed, I am not going to that length was what I meant. I don't like getting into people's business too much, but I try to get to the truth with everything by honest questioning and do things legitimately. TN mountain people aren't always forthcoming or don't understand what I am asking. Don't get me wrong, love my TN brethren.
She isn't full-dual, she is full extra help (she draws a little too much to get Medicaid or Part B premium paid for (SLMB) but gets her PDP for basically free). I have placed a few on med sup in this situation if they would have lots of OOP with MAPD.
- 18,987
I think his point was that it's income based to get the extra help. Ballpark of around $1100/mo. She may or may not be getting her part B premium paid.
Still, a med sup would cost a big chunk of that income. You're talking 10% at least of the monthly income to pay for the sup.
I've seen a few times where someone was willing to do so but it's pretty rare.
I would advise against it but if they are dead set on buying it and will buy from someone else then I'm selling it.
- 359
Well, yes and no. From the UnitedHealthcare TN Eligibility Guidelines:
"Pre-existing conditions will be covered as of the AARP
Medicare Supplement Plan effective date for applicants
who qualify for Open Enrollment or Guaranteed Issue
(see pages 10 and 11) or who are replacing a Medicare
supplement plan or creditable coverage.* For all others,
there is a 3-month waiting period after the plan effective
date before pre-existing conditions are covered.
* Note: Some common examples of creditable coverage
include: Employer group or individual health plan,
Medicare Advantage plan and Medicaid. Medicare
Parts A and B are creditable coverage. However,
individuals who buy Medicare supplement insurance are
keeping, not replacing, Medicare Parts A and B."
That last sentence implies that since the applicant is not replacing creditable coverage, the pre-ex would apply, if not considered OE. At least it's only three months!
And, from the Medigap guide, this:
"If you have a pre-existing condition, you buy a Medigap policy during
your Medigap Open Enrollment Period, and you’re replacing certain
kinds of health coverage that count as “creditable coverage,” it’s possible
to avoid or shorten waiting periods for pre-existing conditions. Prior
creditable coverage is generally any other health coverage you recently had
before applying for a Medigap policy. If you have had at least 6 months of
continuous prior creditable coverage, the Medigap insurance company can’t
make you wait before it covers your pre-existing conditions.
There are many types of health care coverage that may count as creditable
coverage for Medigap policies, but they'll only count if you didn’t have a
break in coverage for more than 63 days.
Your Medigap insurance company can tell you if your previous coverage will
count as creditable coverage for this purpose."
So, it sounds as if insurers have a bit of latitude in definition of creditable coverage. Further, how would a carrier know if one had his coverage for at least six months or not?
- 6,457
My guess (based on part A start date) is that she probably automatically got both parts A and B in 2004 (age 59) after 24 mos on disability. If she had not yet gone to prison when she turned 65, both A and B would have continued at that point. Whenever she went to prison, part B coverage dropped away because she did not pay (or have paid on her behalf) her part B premium. Part A stayed in force because it does not require a premium payment. She has already had her turning 65 initial enrollment period and does not get another one.
I don't know this, but that probably leaves the underwriting issue to be a carrier by carrier based decision as others have suggested.
- 29,487
Look at her card and go by that. Every Med Supp app I've seen asks for the start date of Part A and Part B. If you do a POS, they'll ask her what her Medicare Claim # is and the A and B start date. Answer honestly and it should be good to go. As stated earlier, the pre-existing waiting period depends on which carrier you use.
- 6,457
Based on a 2-3 month dispute I had with a GHP carrier over coordination of benefits issues earlier this year, I have to assume that the insurance carriers have access to your medicare account data. When I applied for part B, I had to document prior coverage in order to avoid Part B penalties. What I see in mymedicare account now is GHP coverage back to my part A effective date in far more detail than anything I gave SS.
So I'd say, all the ins co has to do is check your medicare file and act on the data or lack of data that it contains.
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