SEP Eligible if MAPD Active?

SirLurkAlot

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73 year old Texas resident enrolled in a Humana MAPD at 65 years old. Later he started a full-time job that provided him BCBS employer coverage but he also has kept his Humana MAPD. He is leaving his job and losing the BCBS coverage as of Sept. 1 and wants to get a med supp due to health issues. I assume because he already has a MAPD in place that he does not get an SEP, but wanted to just make sure. Appreciate the feedback!
 
I wouldn't think he would have an SEP in this situation. He'll have to qualify for that Med Supp, which should begin on 1/1/17.
 
I would say if he cancels MA first and gets letter from employer on losing group then he probably has a good shot, and if all else fails he will have SEP to get MA back
 
73 year old Texas resident enrolled in a Humana MAPD at 65 years old. Later he started a full-time job that provided him BCBS employer coverage but he also has kept his Humana MAPD. He is leaving his job and losing the BCBS coverage as of Sept. 1 and wants to get a med supp due to health issues. I assume because he already has a MAPD in place that he does not get an SEP, but wanted to just make sure. Appreciate the feedback!



I am pretty sure the letter of termination of coverage from the BCBS plan is all he needs for a GI no matter what other insurance he has..The only thing i see gunking that up at the underwriters desk is on the med supp application they will see he still has a MA plan that isn't terminated before 9/1/16.I would let his MA plan ride thru Sep. use SEP Loss of EGHP ( 63 days) for a 10/1/16 enrollment in to PDP after the Med supp application is approved first for a 10/1/16 effective date.
 
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It's illegal to sell a Med Supp to someone who has a Med Advantage. The beneficiary must disenroll from the Med Adv plan from Jan 1--Feb 14 and return to Original Medicare and then apply for a Med Supp.

My feelings are he does not qualify for a SEP because, although he is losing his group coverage, he has a Med Advantage plan in effect.

When in doubt, call the insurance company directly and ask. I do it all the time.
 
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It's illegal to sell a Med Supp to someone who has a Med Advantage. My feelings are he does not qualify for a SEP because, although he is losing his group coverage, he has a Med Advantage plan in effect.

When in doubt, call the insurance company directly and ask. I do it all the time.

It's not illegal to write it as long as the MA plan has an end date and the effective date of the Med Supp is after the end date, but it's still a valid point. He he can pass through the Med Supp underwriting, just make this simple and have his drop his MA effective 12/31/16 and make the effective date of the supp 1/1/17. Why go through getting letters of termination from the group coverage and all that when there's so little time between that and when he can drop it on his own anyway?

Of course, all the above is predicated on him being able to pass through UW for the supp.

What are his health issues?
 
Thanks for the replies. Just wanted to confirm what I was thinking. He cannot get through underwriting as he recently had lots of his intestines removed due to diverticulitis.
 
Thanks for the replies. Just wanted to confirm what I was thinking. He cannot get through underwriting as he recently had lots of his intestines removed due to diverticulitis.


I think he might be able to pass UW with some companies. If he's been released from the Dr., Aetna will consider him. Call some of the companies in your bag and ask them. Don't settle for $25 if you don't have to.
 
It's illegal to sell a Med Supp to someone who has a Med Advantage. The beneficiary must disenroll from the Med Adv plan from Jan 1--Feb 14 and return to Original Medicare and then apply for a Med Supp.

My feelings are he does not qualify for a SEP because, although he is losing his group coverage, he has a Med Advantage plan in effect.

When in doubt, call the insurance company directly and ask. I do it all the time.




Do you think it is illegal if someone has a group MA plan and want to change to med supp? happens all the time.

It will be GI because its loss of the EGHP plan that matters here.Irevelent that he has an MA plan too.The enrollment in to PDP ( using loss of EGHP SEP) will disenroll him from MA.

I would do a 10/1/16 effective date but even then a replacement from must be signed because MA enrollment would still be within 63 days.This is where i would chose the med supp carrier that is least likely to confuse this.I have used AARP/UHC in very similar circumstances and didn't have any issue.
 
When I have an under 65 with MAPD and they age in, the carrier I prefer for Supps will accept the application. They have access to the CMS portal. They just run a report every day and once they see the client is or will be disenrolled, they issue it. Nothing illegal about it since client put termination date on the app and signed it.

Not sure about the other scenario...that's a good one. I'm thinking unless he got that employer coverage within the first six months of turning 65, I'm leaning no GI. I don't even think the MA comes into play here except for the making sure you disenroll part. The only MA related GI I can think of is if you cancel within the first 12 months of taking it turning 65.

....just to be technical, use 'SEP' lingo for MAPD/PDP. It's just not used with Supps.
 
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