Missed Medigap enrollment time

H

hersh

New Member
Hi,

I'm posting on behalf of my dad who has no knowledge of how to operate computers.

He was born in May 1947. He signed up for original Medicare when he was eligible, but he missed on his medigap enrollment period.

He always has had PPO medical insurance from his work. He still has that insurance. However, he is going to be retiring upcoming year and hence he wants to signup for medigap.

Is it still possible for him to sign up for Medigap?

I see on medicare.gov that his medigap enrollment period started when he signed up for Medicare part B. So this makes me think he is not eligible any more. He shouldn't have signed up for part B since he already had medical insurance.

However, I also see that guaranteed issue rights say:

  • You have Medicare A and B but you have been using an employer group plan for your Medical coverage and it ends or is discontinued

So, does that mean when my dad retires and loses his coverage, then he is eligible for Medigap?

thanks.
 

The best thing to do, and the best and easiest way to get accurate information is to call 1-800-MEDICARE and talk to them. They have the correct and up-to-date information about what to do.

I agree with Ken and think he would have at least until 12/7; but in his situation it might be longer since he has the insurance through his employer. It's complicated, which is why he should get the true scoop from Medicare. He should do this right away, though, so as not to risk any late penalties or not being able to enroll until the following year.

The people at Medicare are very helpful, and you can make an appointment for them to call you back if you don't want to wait for an agent. They really DO call you back. Just tell him not to fool around and wait too long to get the information. He should also be sure he has Part D or Part D in his medigap plan or he can incur penalties trying to enroll at a later date.

December 7 s approaching rapidly, so he should not wait to get the information.
 

Butterfly said:
The best thing to do, and the best and easiest way to get accurate information is to call 1-800-MEDICARE and talk to them. They have the correct and up-to-date information about what to do.

I agree with Ken and think he would have at least until 12/7; but in his situation it might be longer since he has the insurance through his employer. It's complicated, which is why he should get the true scoop from Medicare. He should do this right away, though, so as not to risk any late penalties or not being able to enroll until the following year.

The people at Medicare are very helpful, and you can make an appointment for them to call you back if you don't want to wait for an agent. They really DO call you back. Just tell him not to fool around and wait too long to get the information. He should also be sure he has Part D or Part D in his medigap plan or he can incur penalties trying to enroll at a later date.

December 7 s approaching rapidly, so he should not wait to get the information.
Click to expand...

Sounds good, thanks!
 
Actually, the best thing to do is call an insurance agent. It's really an insurance question, not a Medicare A/B question.

The December 7 deadline is for plans that cover drugs, either stand alone Part D or Medicare Advantage.

There is no need for him to do anything as long as he has coverage from work. If you'd like to talk please give me a call and I'll be happy to explain how this can work. (I'm only licensed in a few states but his rights apply anywhere).

Rick
818-342-9200
 
Hersh
There is a lot of unknowns to give you a complete answer. Your father can get a Medicare supplement policy if his health is good. The state he lives in can be a factor. Are you looking at a Medicare Supplement policy (Medigap) or are you looking at an Advantage plan? He is still working, then that can change things. The best thing to do is find an insurance broker that specializes in Medicare. I've been doing this for 28 years and I'm licensed in most every state.
If you know what plan you want I could supply you a quote of every insurance company in your zip code.

Jim Grude
(800) 275 1844
 
Ken N Tx said:
I believe he has until 12/7 to get Medigap..
Click to expand...

That is what most people believe in the country, but the truth of the matter is a Medigap plan can be purchased at anytime of the year. Open enrollment only applies to Advantage plans (Medicare part C) and the prescription drug plans. If a person has a Medigap plan they can apply with a different company at anytime of the year.
 
hersh said:
Hi,

[. . .]
However, I also see that guaranteed issue rights say:

  • You have Medicare A and B but you have been using an employer group plan for your Medical coverage and it ends or is discontinued

So, does that mean when my dad retires and loses his coverage, then he is eligible for Medigap?

thanks.
Click to expand...

The answer is (almost certainly) yes, provided that your dad is covered by his employer's policy up until the effective date of the Medigap (Medicare supplement) policy:

[h=1]Guaranteed issue rights[/h] Guaranteed issue rights (also called "Medigap protections") are rights you have in certain situations when insurance companies must offer you certain Medigap policies. In these situations, an insurance company:


  • Must sell you a Medigap policy
  • Must cover all your pre-existing health conditions
  • Can't charge you more for a Medigap policy because of past or present health problems
In most cases, you have a guaranteed issue right when you have other health coverage that changes in some way, like when you lose the other health care coverage.
Click to expand...

See here.

Also, before calling Medicare directly, I suggest calling your dad's State Health Insurance Assistance Program. Those programs (usually called SHIPs) are run by dedicated and well-trained people, many of them volunteers, who tend to know what they are talking about and be willing to go the extra mile to make sure that people like your dad get the information and coverage he needs.

Best of luck!

~Doug
 
chrisgjim said:
That is what most people believe in the country, but the truth of the matter is a Medigap plan can be purchased at anytime of the year. Open enrollment only applies to Advantage plans (Medicare part C) and the prescription drug plans. If a person has a Medigap plan they can apply with a different company at anytime of the year.
Click to expand...

Yes, that's true, but, only during certain, very limited times and periods do beneficiaries/potential beneficiaries have "guaranteed issue rights." Outside of those periods, the carriers are not required to issue a policy and may decide to use "medical underwriting" to determine whether to issue one and how much to charge. They may also exclude, for varying periods of time, coverage for pre-existing conditions.

These conditions apply whether a beneficiary/potential beneficiary already has Medicare supplemental plan, or not.

[h=1]When can I buy Medigap?[/h]
[h=2]Buy a policy when you're first eligible [/h] The best time to buy a Medigap policy is during your 6-month Medigap open enrollment period. During that time you can buy any Medigap policy sold in your state, even if you have health problems. This period automatically starts the month you're 65 and enrolled in Medicare Part B (Medical Insurance). After this enrollment period, you may not be able to buy a Medigap policy. If you're able to buy one, it may cost more.
Click to expand...
 
UncleDoug said:
Yes, that's true, but, only during certain, very limited times and periods do beneficiaries/potential beneficiaries have "guaranteed issue rights." Outside of those periods, the carriers are not required to issue a policy and may decide to use "medical underwriting" to determine whether to issue one and how much to charge. They may also exclude, for varying periods of time, coverage for pre-existing conditions.

These conditions apply whether a beneficiary/potential beneficiary already has Medicare supplemental plan, or not.
Click to expand...

There are no pre-existing exclusions when changing from one plan to another.

Rick
 
GreenSky said:
There are no pre-existing exclusions when changing from one plan to another.

Rick
Click to expand...

That's not quite correct. Indeed, it's sufficiently incorrect to be bad information to be posting.


Can I switch policies?

In most cases, you won't have a right under Federal law to switch Medigap policies, unless one of these applies:



  • You're eligible under a specific circumstance or guaranteed issue rights
  • You're within your 6-month Medigap open enrollment period

You don't have to wait a certain length of time after buying your first Medigap policy before you can switch to a different Medigap policy [assuming you have a right to switch and/or a carrier is willing to sell you a different policy ~Doug].


I've had my old Medigap policy for less than 6 months & have a pre-existing condition.

 The Medigap insurance company may be able to make you wait up to 6 months for coverage of pre-existing conditions. The number of months you've had your current Medigap policy must be subtracted from the time you must wait before your new Medigap policy covers your pre-existing condition.
If you've had your Medigap policy less than 6 months:

The number of months you've had your current Medigap policy must be subtracted from the time you must wait before your new Medigap policy covers your pre-existing condition.

If the insurance company agrees to issue the new policy, they can't write [new or additional ~Doug] pre-existing conditions, waiting periods, elimination periods, or probationary periods into the replacement policy.

You may still have to wait up to 6 months before that benefit will be covered, regardless of how long you have had your current Medigap policy.


I've had my old Medigap policy for 6 months or more and it had the same benefits as my new policy.

The new insurance company can't exclude your pre-existing condition.
Click to expand...

See "Switching Medigap Policies.


The devil is always in the details and the Medicare/Medigap/Part D details are extremely complex.

In Minnesota, I have recently learned, your assertion would be generally correct -- because the state has been granted waivers by CMS to alter the standard Medigap plans, formulate two of its own, and mandate specific requirements carriers must follow. Unfortunately (for this purpose anyway), only about five-and-a-half million of the 323 million Americans live in Minnesota.

~Doug
 
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UncleDoug said:
That's not quite correct. Indeed, it's sufficiently incorrect to be bad information to be posting.

~Doug
Click to expand...

Well Doug. Thanks for the insult.

Indeed, if someone only has a plan for a month then they would be subject to pre-ex until they have satisfied either 3 months (UHC) or 6 months of waiting. However, if a person has had a plan for at least as long as the new plan's pre-ex limitation then it is waived.

I try to keep my posts brief without writing a book. My general statement was correct.

Rick
 
GreenSky said:
Well Doug. Thanks for the insult.

Indeed, if someone only has a plan for a month then they would be subject to pre-ex until they have satisfied either 3 months (UHC) or 6 months of waiting. However, if a person has had a plan for at least as long as the new plan's pre-ex limitation then it is waived.

I try to keep my posts brief without writing a book. My general statement was correct.

Rick
Click to expand...

It wasn't my intention to insult you, Rick. If you feel insulted, it's probably because you react badly to being corrected.

Sometimes "brief" isn't sufficient to convey very important points. So, don't be too proud of yourself for not "writing a book" (that was intended to be an insult, wasn't it?).

As I said, and then explained carefully, with links to the source materials and expert explanations, your statement was "sufficiently incorrect to be bad information." I'm sorry that upset you, but the subject here is a very important one and the consequences of accepting bad or incomplete advice and interpretations can be serious, costly and dangerous to health. That's more important than your feelings.

As I pointed out in my introductory post, I've been doing patient advocacy for about 40 years. If you are going to challenge me, it's a good idea to do your homework -- carefully. BTW, your defensive explanation, to which this is a response, is also vague and not particularly adequate.

I'll let other readers/members make their own judgments about who, here, is providing the better advice and information.

~Doug
 
UncleDoug said:
It wasn't my intention to insult you, Rick. If you feel insulted, it's probably because you react badly to being corrected..

~Doug
Click to expand...

I'll give you the last 1,000 words if you wish. What I posted was indeed correct so let's see how you answer this scenario:

John has had a Plan F supplement since turning 65 3 years ago.
He realized that Plan G is a better value so moved to another company.
What pre-existing exclusion exists for him?

I'll give you a hint. There is only ONE correct answer. And when you look up the answer to post you can then let everyone know why my prior posts were incorrect (good luck with that).

If you're going to challenge me you better do your homework -- carefully. I have 40 years experience as an insurance agent so I think I have learned a thing or two.

Rick
 
GreenSky said:
I'll give you the last 1,000 words if you wish. What I posted was indeed correct so let's see how you answer this scenario:
[. . .]
What pre-existing exclusion exists for him?
Click to expand...

Any pre-existing condition exclusion or waiting period that the new carrier's cold, hard heart desires may apply to John's new policy, because the new plan doesn't have the same benefits as the previous one.

Can I switch policies?

In most cases, you won't have a right under Federal law to switch Medigap policies, unless one of these applies:


  • You're eligible under a specific circumstance or guaranteed issue rights
  • You're within your 6-month Medigap open enrollment period

You don't have to wait a certain length of time after buying your first Medigap policy before you can switch to a different Medigap policy.

See the situations below on switching Medigap policies.

I have an older Medigap policy. [Not relevant here]

I've had my old Medigap policy for less than 6 months & have a pre-existing condition. [Not relevant here]

I've had my old Medigap policy for 6 months or more and it had the same benefits as my new policy. [Not relevant here (although you seem to think it is) because plan G does not have the same benefits as plan F. For instance, plan G doesn't cover the Part B deductible. Nevertheless:]

* The new insurance company can't exclude your pre-existing condition.
[. . .]
*You may still have to wait up to 6 months before that benefit will be covered, regardless of how long you have had your current Medigap policy.
The new Medigap policy has a different benefit that isn't in my current Medigap policy. [Not relevant here, unless you believe the lack of coverage of the Part B deductible is a benefit. Neverthless:]

* You may still have to wait up to 6 months before that benefit will be covered, regardless of how long you have had your current Medigap policy.

I'm moving out of state. [Not relevant here.]

I have a Medicare SELECT policy & I'm moving out of the policy's area. [Not relevant here.]

I'm joining a Medicare Advantage Plan [Not relevant here.]
Click to expand...
If you're going to challenge me you better do your homework -- carefully. I have 40 years experience as an insurance agent so I think I have learned a thing or two.

Rick
Click to expand...

But not enough to know what you're talking about in this case. Read, and actually understand, the regulations!

And learn the first rule of holes: When you realize you're in one. . .

Now, I'm finished with this exchange.
 
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UncleDoug said:
Any pre-existing condition exclusion or waiting period that the new carrier's cold, hard heart desires, because the new plan doesn't have the same benefits as the previous one.
.
Click to expand...

I promised not to respond but I will now. You are 100% wrong. In the scenario I wrote there would be no pre-existing exclusions. Period.

Just because you've been an advocate for 40 years doesn't mean you understand how insurance really works.

So go ahead and tell everyone that a 40 year licensed professional with over 600 clients doesn't know what he's talking about.

This time I really am done with you. Keep scaring people into believing there could be a problem with pre-existing conditions when none exists.

Rick
 
As an aside, I recently moved to AZ. Had been on Florida Blue Plan F for 5 years, and wanted to chance to AZ Blue Plan F to avoid the "out of state" surcharge (about $35/month). I had to answer a number of health questions in order to qualify for the AZ policy.

YMMV
Hoot
 
I, also, said I was finished, but. . .

So go ahead and tell everyone that a 40 year licensed professional with over 600 clients doesn't know what he's talking about.
Click to expand...

OK, I will. "Folks, in this instance, Rick doesn't know what he's talking about."

You don't have to believe me, you just have to read and understand the relevant regulations. To support my argument, I have, repeatedly, posted here, with links and emphasis, the explanations provided by CMS, the "Center for Medicare and Medicaid Services," the part of the Department of Health and Human Services ("HHS") that runs Medicare and writes the rules that govern Medigap policies. Rick has not cited a single source, authoritative or otherwise, to support his assertions. He has merely claimed that his experience selling insurance policies makes him so expert that we should believe him.

Forty years of selling cars wouldn't make the salesperson an expert on auto engineering or traffic law and this situation is analogous.

As an aside, about three years ago, I studied for, took and passed the California exam required for "Accident and Health" agents. The prelicensing requirements are 20 hours of "General Insurance Prelicensing Education" and 12 hours of "Ethics and California Insurance Code Prelicensing Education" (periodically, a few hours of continuing education are required). The exam itself consisted of 75 questions to be answered in an hour and a half. I had no interest in selling insurance; I just wanted to get a feel for the environment as experience by people "on the other side of the fence." Virtually every word of the "education" material was geared toward teaching "producers" (that's what they call them in the industry) how to more effectively push policies without being tripped up by annoying laws and regulations.

Assuming no state law prohibited it and a carrier wanted to issue it, Rick absolutely could have sold "John" that plan G he to which he referred above. But the policy absolutely could have included exclusions and/or waiting periods, and the company could have engaged in "medical underwriting" (used John health information to decide whether or not to issue the policy and, if it did, how large a premium to charge).
 
Uncle Doug, you are dangerous. You know nothing about insurance yet continue to post.

Take a look at page 33 from the "2017 Choosing a Medigap Policy" published by CMS. It states "If your new Medigap policy has a benefit that isn't in your current Medigap policy, you may still ahve to wait up to 6 months before that benefit is covered, regardless of how long you've had your current Medigap policy." https://www.medicare.gov/Pubs/pdf/02110-Medicare-Medigap.guide.pdf

Perhaps if you'd read more than just what you want to believe you could learn something.

And as far as your insurance "education," that's no more or less than any of us had and still have to do.

Based upon what is written by CMS (since plan g contains no additional benefits to plan f), you're answer is 100% wrong. Go get educated. I've been teaching agents about Medicare plans for over 10 years. What have you done in the real world other than not understanding what you've been reading?

Rick
 
GreenSky said:
Uncle Doug, you are dangerous. You know nothing about insurance yet continue to post.

Take a look at page 33 from the "2017 Choosing a Medigap Policy" published by CMS. It states "If your new Medigap policy has a benefit that isn't in your current Medigap policy, you may still ahve [sic] to wait up to 6 months before that benefit is covered, regardless of how long you've had your current Medigap policy."
Rick
Click to expand...

Yeah, Rick. And that's totally irrelevant to the disagreement at issue. Let's quote more of the source:

[. . .] If you’ve had your old Medigap policy for less than 6 months, the Medigap insurance company may be able to make you wait up to 6 months for coverage of a pre‑existing condition. However, if your old Medigap policy had the same benefits [THE SAME BENEFITS], and you had it for 6 months or more, the new insurance company can’t exclude your pre‑existing condition. If you’ve had your Medigap policy less than 6 months, the number of months you’ve had your current Medigap policy must be subtracted from the time you must wait before your new Medigap policy covers your pre‑existing condition. If the new Medigap policy has a benefit that isn’t in your current Medigap policy, you may still have to wait up to 6 months before that benefit will be covered, regardless of how long you’ve had your current Medigap policy.

If you’ve had your current Medigap policy longer than 6 months and want to replace it with a new one with the same benefits [THE SAME BENEFITS] and the insurance company agrees to issue the new policy, they can’t write pre‑existing conditions, waiting periods, elimination periods, or probationary periods into the replacement policy.
Click to expand...

Your "John's" desired plan G does not have the same benefits as plan F. I've already explained this. If a carrier decides to sell him plan G, it can use medical underwriting and can apply whatever waiting periods and exclusions it wished (and John agrees to -- buy buying the policy).

Sheesh, This is a pathetically ridiculous argument. I'm not sure I want to hang out in a forum where people like you can get away with representing themselves as experts. Because you, if you are still selling health insurance, are truly dangerous. And, if you're not still doing so, you have likely created ongoing risk for at least some of those 600 clients of yours.
 
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Good bye Uncle Doug. Come back when you learn insurance.

I proved exactly my point by showing you where CMS agrees with me but you're too proud to admit it. Go back to ill advising seniors. I'll keep actually providing help.

Rick
 
Why are you so rude? Rick is completely correct. I've been in this business for 28 years, so I have some experience. If you are replacing a Medicare Supplement policy with another and you disclose everything on the application there will be no preexisting condition. You are taking your information from I assume this "You may still have to wait up to 6 months before that benefit will be covered, regardless of how long you have had your current Medigap policy". Not one of the 15 companies I have a contract with have that exclusion, and all my companies are major insurance companies in this market.

You say that you have been a patient advocate for many years and it does look like you have good knowledge about Medicare. Let me ask you, do you hold an insurance license and how many companies are you contracted with? If your not licensed with these companies then you have no knowledge of the underwriting rules of the company. Every company has their own underwriting rules and any agent that represents that company better know those rules. In my 28 years of selling Medicare supplements I have never had a claim denied because of a prior condition. As an example I have companies that when you turn 65 if you are a smoker they will give you non smoker rates. I have a company that there is no underwriting and they have no preexisting clause. Insurance companies have to follow Medicare guidelines and rules but when it comes to underwriting they are allowed to set their own standards.

I think you owe Rick an apology.

Jim


 
More irrelevant, off-point babbling from another policy pusher.

chrisgjim said:

I think you owe Rick an apology.

Jim
Click to expand...

And I think you and Rick are the insurance equivalents of used car salesmen: hustlers who know only enough to make the sale.

I'm afraid I don't think of the work you do as an honorable profession, and your smug belief in your fuzzy understanding doesn't raise you in my estimation.

Look up "Dunning-Kruger." You and Rick are textbook cases. Of course, you'll think that I am -- that's one of the signal symptoms of the syndrome.

What have we learned from this exchange? We have learned that Rick and Jim believe that, between them, they have 68 years of experience, when what they really have is one year of experience and learning, repeated 67 times.

I'm rude because (a) both of you deserve it and (b) I hope it jolts at least a few readers into paying no attention to you at all.

Clear enough?

~Doug
 
Let me make this clear Uncle Doug. You are wrong and I hope you don't harm those who trust you.

I would insult your intelligence but don't want to lower myself to your level.

Now go away. I really wish you'd get banned for being a jerk.

Rick
 

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