Guaranteed Issue Rights for Medi-Gap when you enroll beyond age 65 for Part B
as you had Qualifying Employer Coverage

 

Situation  1
from Blue Shield CA Guaranteed Acceptance Guide

Situation 1 - New to Part B
Situation 1 – New to Part B

Learn More about not enrolling in Part B if you have employer coverage

Situation 4
You received notice of termination, or your coverage was terminated from any employer-sponsored health plan, including an employer-sponsored retiree health plan. This includes termination for loss of eligibility due to divorce or death of a spouse.
Your plan choices
Plan A, C, D, F, High Deductible F, K, or N
When to apply Blue Shield must receive your application within six (6) months of the notice of termination, or if no notice is received, within six (6) months  of the date your employer-sponsored health coverage ended.
You must supply this documentation
Be sure to complete the Current Insurance Coverage information section (including the end date) of your signed Medicare Supplement plan application
***

Termination of Employment or Retirement Plan

You have the right to purchase a Medigap policy for 6 months if your, your spouse’s or a family member’s current employment or retirement plan coverage terminatesor you lose your eligibility due to divorce or death of a spouse or family member. The 6-month period to apply for a Medigap policy starts on the date you receive notice that your health benefits will end. If you do not receive advance notice, the 6-month period starts the date the benefits end or the date of your first denied claim. This protection of California law applies whether your group health benefits were primary or secondary to Medicare.

Note: You are also entitled to this protection when you become eligible for COBRA or have used up all your COBRA benefits. It does not apply if you stop paying COBRA premiums before you use all your benefits. COBRA benefits are always secondary to Medicare benefits unless you have ESRD and are in a 30-month coordination period. For more information on COBRA, see Medicare & Other Health InsuranceCA HealthCare Advocates  *

Situation  11
You enrolled in an employer-sponsored health plan that supplements Medicare, [§419 (e) Welfare Benefit Plans ] and either of the following apply:
• The plan either terminates or ceases to provide all of those supplemental health benefits to you;
or
• The employer no longer provides you with insurance that covers all of the payment for the 20% coinsurance.
Your plan choices
Plan A, C, D, F, High Deductible F, K, or N
When to apply
You may submit an application to Blue Shield during the guaranteed acceptance period, which starts from the later of the following two dates, and ends sixty-three (63) days after the date coverage is terminated:
• The date you received a notice of termination, or if no notice is received, on the date you received notice denying the claim because of
termination of benefits;
or
• The date coverage is terminated.
You must supply this documentation
Be sure to complete the Current Insurance Coverage information section  (including the end date and reason for coverage ending) of your signed Medicare Supplement plan application.
Why is there Both situation 4 and 11?
I asked and was told # 11 applies to §419 (e) Welfare Benefit Plans 
See everything in the  Blue Shield Guaranteed Issue Guide
CA Insurance Code  §10192.11

(e)

(1) An individual enrolled in Medicare Part B is entitled to open enrollment described in this section for six months following:

(A) Receipt of a notice of termination or, if no notice is received, the effective date of termination from any employer-sponsored health plan including an employer-sponsored retiree health plan.

(B) Receipt of a notice of loss of eligibility due to the divorce or death of a spouse or, if no notice is received, the effective date of loss of eligibility due to the divorce or death of a spouse, from any employer-sponsored health plan including an employer-sponsored retiree health plan.

(C) Termination of health care services for a military retiree or the retiree’s Medicare eligible spouse or dependent as a result of a military base closure or loss of access to health care services because the base no longer offers services or because the individual relocates.

(2) For purposes of this subdivision, “employer-sponsored retiree health plan” includes any coverage for medical expenses, including, but not limited to, coverage under the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) and the California Continuation Benefits Replacement Act (Cal-COBRA), that is directly or indirectly sponsored or established by an employer for employees or retirees, their spouses, dependents, or other included insureds.

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Resources & Links
Technical Memo:
Interaction between COBRA and Medigap Guaranteed Issue Requirements in Situations Involving Termination of Employer Group Coverage
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7 comments on “Loss of Employer Coverage – New to Part B

  1. This is utterly confusing. It says six month period of eligibility but that you must apply within 63 days of termination? Makes no sense to me.

    • Right. Please send a copy of your termination notice and if at all possible, all documents from your Employer’s Health Plan. Don’t hold back. We need to see if your under situation 4 or 11.

      Did the plan supplement Medicare or not?

  2. If one gets terminated from their spouses retiree benefits plan when the spouse passes away is there a guaranteed enrollment period into Medi Gap and how does it work?

    • Good POINT!

      Excerpt from Medicare Medi Gap Guide # 02110 * Medicare.Gov *

      It’s also important to understand that your Medigap rights may depend on when you choose to enroll in Medicare Part B. If you’re 65 or older, your Medigap Open Enrollment Period begins when you enroll in Part B and it can’t be changed or repeated.

      In most cases, it makes sense to enroll in Part B and purchase a Medigap policy when you’re first eligible for Medicare, because you might otherwise have to pay a Part B late enrollment penalty and you might miss your Medigap Open Enrollment Period. However, there are exceptions if you have employer coverage.

      From prior conversations and emails, you’ve stated that you have an application pending for Part B, but have not been enrolled. I’d check and see if you can get the application cancelled, as if you never asked to be enrolled in Part B.

      Either you or I can write to HICAP – CA Advocates and see what light they can put on the subject.

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