Trial Rights/Med/Supp 1st 12 Months

[yorkriver1]

Waiting for the spouse to call me, meanwhile researching options. The family may have already found this out, but as I read the trial rights section of the Choosing a Medigap Policy CMS booklet, p. 23, a person who bought 1 kind of Medicare Advantage coverage in April 2014 upon T65, then switched to another for 1/1/15, would not be eligible for the Trial Right to purchase a Medigap policy, even if still in the 1st year of T65. That may have happened.
Have been referred to a client's family member who is in the last month before turning 66. Pretty ill right now, so wouldn't pass the UHC 2 question underwriting for the after 6 mo/before 3 years of T65 window.
Without trial rights, then looking for the best docs in the Humana HMO network. Can switch to one of the other carriers MAPD PPO next January, will see if either of the teaching hospitals in the area are in those networks.
The family may be able to apply for financial aid at the teaching hospital, also. Not likely to be Medicaid eligible.
Your thoughts?

 

[goillini52]

Waiting for the spouse to call me, meanwhile researching options. The family may have already found this out, but as I read the trial rights section of the Choosing a Medigap Policy CMS booklet, p. 23, a person who bought 1 kind of Medicare Advantage coverage in April 2014 upon T65, then switched to another for 1/1/15, would not be eligible for the Trial Right to purchase a Medigap policy, even if still in the 1st year of T65. That may have happened.
Have been referred to a client's family member who is in the last month before turning 66. Pretty ill right now, so wouldn't pass the UHC 2 question underwriting for the after 6 mo/before 3 years of T65 window.
Without trial rights, then looking for the best docs in the Humana HMO network. Can switch to one of the other carriers MAPD PPO next January, will see if either of the teaching hospitals in the area are in those networks.
The family may be able to apply for financial aid at the teaching hospital, also. Not likely to be Medicaid eligible.
Your thoughts?

That's a good question. I just checked with ACI and they said you're good to go. On the app, just write in their current MA and don't mention the previous MA.

 

[WCMason]

That's a good question. I just checked with ACI and they said you're good to go. On the app, just write in their current MA and don't mention the previous MA.

That's good to hear as I write a lot with Aetna. They will have to send copy of MA card with the med supp app to prove GI eligibility. I'd have assumed the effective date of 1/1/15 on the ID card would reveal it's not first MA when turning 65 and cause the app not to pass through to issue. I've told people that an AEP plan switch in first year ends the trial right. But if they'll honor the GI for first 12 months even with an MA plan switch I'll write 'em up.

 

[somarco]

I don't have an Aetna app in front of me, but don't they ask "Is this your first time in an MA plan? Did you drop a Medigap to enroll in the MA plan?"

Thought that was pretty much SOP for carriers.

 

[WCMason]

I don't have an Aetna app in front of me, but don't they ask "Is this your first time in an MA plan? Did you drop a Medigap to enroll in the MA plan?" Thought that was pretty much SOP for carriers.

Section 3 b "Was this your first time in this type of Medicare plan?"

 

[somarco]

Section 3 b "Was this your first time in this type of Medicare plan?"

OK, maybe I am missing something. Been a long day and didn't get much sleep last PM.

Question 3b negates the trial right but Tom's post seems to say Aetna would still accept it.

Or are we splitting hairs here?

 

[cadylou]

OK, maybe I am missing something. Been a long day and didn't get much sleep last PM. Question 3b negates the trial right but Tom's post seems to say Aetna would still accept it. Or are we splitting hairs here?

no hairs to split--they've forfeited eligibility for guaranteed issue. It's a ONE TIME trial right. Once they've gone to a 2nd MA plan, it's over.

 

[WCMason]

OK, maybe I am missing something. Been a long day and didn't get much sleep last PM. Question 3b negates the trial right but Tom's post seems to say Aetna would still accept it. Or are we splitting hairs here?

Never submitted a trial right GI app when prospect was in second MA in first 12 months, but after being reminded of question 3b would bet it would get declined despite the carrier rep's response. On an Eapp no way it would allow GI.

 

[goillini52]

no hairs to split--they've forfeited eligibility for guaranteed issue. It's a ONE TIME trial right. Once they've gone to a 2nd MA plan, it's over.

I think it'll depend on the company. ACI's UW department says they'll take it. Feel free to call and ask.

 

[cadylou]

I think it'll depend on the company. ACI's UW department says they'll take it. Feel free to call and ask.

Well, if they'll do it that's great. It's not how the federal guidelines work, or how most apps ask the question so . . . You just don't want to be vulnerable to future problems unless you're certain.