An Open Enrollment Question U Cant' Answer

[selfgen]

Is it the application date alone that must be within the 6 month open enrollment period when someone turns 65, or must the EFFECTIVE DATE of the Medigap policy ALSO be within the 6 month window? An insurance company is telling me that both conditions are necessary and it puts my applicant on the outside looking in.)The CMS phone rep couldnt verify the insurance company's interpretation of the conditions and I have a feeling that the insurance company didnt want this applicant due to the fact that he is an adverse risk. His open enrollment is up at the end of October, he applied in mid October and requested a Nov. 1 effective date, which is outside the window. Furthermore The insurance company will not issue a policy with an effective date of the 30th or 31st, AND he wont be off of his MAPD plan until the 31st of OCtober, so no day in October would be a valid date due to this fact. They are suggesting we use the MAPD GI period to return to his previous Medigap. His previous Medigap uses the same TPA as the one in question, so they knew the applicant's claim history. I should have seen this coming. Can anyone here verify that indeed the EFFECTIVE DATE must be within the 6 month window?

 

[G.Gordon]

In his case, to use the OEP it must go into effect in the six month window. If the company has filed their guidelines that they don't issue the 30/31 dates then apply for the 29th. Two days of wasted coverage is not a huge deal.

 

[WCMason]

The Nov 1 start date should work. I've submitted OE apps with a start date of the 1st day of the month exactly six months from Part B effective date. Otherwise you get an additional six months GI trial right if prospect took the MA at 65, first time, first year.

 

[G.Gordon]

The Nov 1 start date should work. I've submitted OE apps with a start date of the 1st day of the month exactly six months from Part B effective date. Otherwise you get an additional six months GI trial right if prospect took the MA at 65, first time, first year.

That is company dependent. They can kick it back to you if they don't want to. They are OEP during the six months including the month they t65. If October is the sixth month, then November 1 is outside that. Most companies will not be this big of a dick over one day.

You should out the company so we all know.

 

[yogooglethis]

The Nov 1 start date should work. I've submitted OE apps with a start date of the 1st day of the month exactly six months from Part B effective date. Otherwise you get an additional six months GI trial right if prospect took the MA at 65, first time, first year.

I have a question for a scenario that is somewhat related to this issue.I have never done this but I was wondering if it is legal or would even get by underwriting .Say you have a prospect who is turning 70 in December and who is currently locked in a MA plan but wants to enroll in a Med supp ASAP which would be 1/1/14

The clients most favorite and the most competitive Med Supp carrier in their issue age rated state has a 66-69 and 70-74 entry age bands and the difference between starting as a 69 yr old vs a 70 year old is about 35.00 a month . The client thinks its well worth wasting 200.00 for 1 month premium for years of having over 400.00 in lower premiums

Would underwriting accept an application for a 11/1/13 effective date if the MA is still in effective? Is the agent put himself on the line selling a Med supp to be effective same time a MA plan is active?

I have had some cases where I could have looked like a superstar agent to my client for pointing this out but just to be safe I never opened up that can of worms.

Anybody else thought about it or suggested it for a client. I know if the coverage was on myself it would certainly do it to save money and I also know it must go unnoticed by some underwriting depts. because I have run in to many cases where a person has had a MA for a long time and a Banker's agent has sold them a Med Supp and both were active.