Med Supp/Med Advantage Question

[SouthernComfort]

Prospect has been in MA for 11 months, they are over 65 and enrolled out of the husbands company group(he retired) into CIP. Now, they want out. The couple qualifies medically for Med Supp, my question is, since they are within the first 12 months of enrolling for the 1st time in a MA, if they dis-enroll can they take out a part D as of today?

 

[midwestbroker]

According to what I have heard:

Medicare supplement to first time MA plan = GI back into a Medicare supp within 12 months

Off group to MA = have 12 months to leave the MA plan but not GI into a Medigap (can go orig Medicare + Part D) - Can get the Medigap if they can pass underwriting

Aging into Medicare = GI into a Medigap within 12 months if their initial choice is a MA plan

Again, this is what I have seen.

 

[WCMason]

Prospect has been in MA for 11 months, they are over 65 and enrolled out of the husbands company group(he retired) into CIP. Now, they want out. The couple qualifies medically for Med Supp, my question is, since they are within the first 12 months of enrolling for the 1st time in a MA, if they dis-enroll can they take out a part D as of today?

The trial rial rights to leave an MA plan and return to Original Medicare and get an SEP for a PDP are allowed in only two situations: 1) The first-time MA enrollment was done when beneficiary turned 65, or 2) the beneficiary left a med supp to enroll in the MA plan. In either case the trial right lasts 12 months.

From your description it does not appear your prospect meets either criteria to qualify to drop the MA and get a PDP or get a GI for a med supp. No harm in trying, though. It could get through. I never have understood why they would write the trial right rules so they excluded those who stayed with an EGHP at 65 then took an MA as their first selection when leaving the employer coverage, but that is how I read them. Would love to be mistaken about that.

 

[Bevo]

The trial rial rights to leave an MA plan and return to Original Medicare and get an SEP for a PDP are allowed in only two situations: 1) The first-time MA enrollment was done when beneficiary turned 65, or 2) the beneficiary left a med supp to enroll in the MA plan. In either case the trial right lasts 12 months.

From your description it does not appear your prospect meets either criteria to qualify to drop the MA and get a PDP or get a GI for a med supp. No harm in trying, though. It could get through. I never have understood why they would write the trial right rules so they excluded those who stayed with an EGHP at 65 then took an MA as their first selection when leaving the employer coverage, but that is how I read them. Would love to be mistaken about that.

For years it had been that they were not GI if they took an MA when T65 and wanted to go supp. I tried multiple times back in the UOO heyday. They could have had a supp for 18 years, then decided to try a MA and had the 12 month, provided they originally took a supplement when T65. If they had just A and B for a few years, then got on a supp, then tried a MA, they wouldn't qualify for GI.

Just a few weeks ago however, I did end up calling a carrier about this (I think it was Aetna, cannot remember as it's been super busy) and they told me otherwise. If they were within 12 months and took the MA when T65 they would be GTG back.

I too always thought it strange that they left out people T65 who were unhappy with their MA. Never made sense.

 

[secondcreek]

Bevo, I lost you with that last sentence. What are you referencing in regard to the T65s?

 

[WCMason]

Bevo, I lost you with that last sentence. What are you referencing in regard to the T65s?

I didn't follow that part either. T65 do get an SEP65 election to drop the MA for a PDP and GI for a med sup. it's the delayed Part B beneficiaries who do not get a trial right if an MA is their first choice according to the rules.