MAPD Trial Priveleges
MAPD Trial Priveleges #02110 Medi-Gap Guide

What are the rules & guarantees about if you get a
Medicare Advantage Plan MAPD and
then you would rather switch to Originial Medicare A-Hospital & B- Doctor Visits and a Medi-Gap plan?

There is a 12 month trial period in which you can test drive an MAPD.  This trial period can be  either when you first turn 65 or you drop a Medi-Gap plan to enroll in a MAPD Plan.

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CA Health Care Advocates *

Publication 02110 Page 23 Choosing a Medi-Gap Policy

What if you are past the 12 month period – but less than 2 years?

Email us and we can send you the information for the unnamed company below.

I don’t like the unnamed company or just want to know how I can get a Medi-Gap plan.

There might be other guaranteed reasons for you.  See our webpage on that.

I don’t have a guaranteed reason, what kind of underwriting is there?

Check the health questions on the paper applications for the Companies we represent.

We’ve found UHC – AARP to be the most liberal.

Trial Period and the 24 Month Rule

This rule is from an unnamed company that doesn’t allow agents to post any meaningful information on their websites.  This company is more liberal than required.  The law says one year.

Scenario 1 – in this situation, an individual currently has a Medicare Supplement and goes to a Medicare Advantage January 1st, 2015 for the very 1st time.

  1. From February 1st, 2015 through December 31st of 2015, the individual will be in a Trial Period and can exit their existing MAPD Plan – they can enroll in an … at any time during the Trial Period – for example, if it is June of 2015 and the member wants to switch to a …with a July 1st effective date, they can do so – also, they can enroll in a PDP for a July 1st effective date.
  2. If the individual choose not to exit their MAPD Plan during the initial Trial Period – January 1st, 2015 through December of 2015, they will no longer have a Trial Period Guarantee Issue option with us – however, they will have an additional guarantee issue opportunity with us if the following holds true – they maintain the same MAPD Plan relationship they had in 2015 – meaning, if they had an MAPD Plan with company ABC, they must continue to have an MAPD Plan with company ABC in 2016 – if they do, they will have three possible windows for a guarantee issue – 1st, the Annual Disenrollment Period (January through February 14th) – 2nd, any available Special Election Period – 3rd, the 2016 Annual Election Period.

 

Scenario 2 – in this situation, an individual enrolls in an MAPD Plan for the very 1st time and they following must take place – first, it must be the first time in an MAPD Plan – second, they must enroll in the MAPD the month their Part A is effective and it must also be the same month the member turns 65 – third, the MAPD Plan must have the same effective date – so, if the member turns 65 in July of 2015, their Part A must be effective in July of 2015 and the MAPD must be effective July of 2015 – if that is the case the following applies:

  1. The individual will be in a Trial Period from July of 2015 through June of 2016 and can exit their existing MAPD Plan – they can enroll in an … Medicare Supplement at any time during the Trial Period – for example, if it is April of 2016 and the member wants to switch to a … Medicare Supplement with a May 1st effective date, they can do so – also, they can enroll in a PDP for a May 1st effective date.
  2. If the individual choose not to exit their MAPD Plan during the initial Trial Period – July 1st, 2015 through June of 201, they will no longer have a Trial Period Guarantee Issue option with us – however, they will have an additional guarantee issue opportunity with us if the following holds true – they maintain the same MAPD Plan relationship they had in 2015 – meaning, if they had an MAPD Plan with company ABC, they must continue to have an MAPD Plan with company ABC in 2016 – if they do, they will have three possible windows for a guarantee issue – 1st, the Annual Disenrollment Period (January through February 14th) – 2nd, any available Special Election Period – 3rd, the 2016 Annual Election Period.

 

Exercise:

 

  1. Individual is 70 years old, had a Medicare Supplement for 5 Years – switched to an MAPD January 1st, 2014 – has maintained the same MAPD relationship – are they in there Trial Period – Answer – yes
  2. Individual is 66 years old – had Medicare Part A and Part B for 6 months – goes to a Medicare Supplement for 6 months and changes to an MAPD for the 1st time January 1st, 2014 – maintains the same MAPD relationship – are they in the Trial Period – Answer – yes
  3. Individual is 75 years old – had an MAPD plan – went to a Medicare Supplement and went back to an MAPD Plan in 2014 – do they have a Trial Period – Answer – no (second time in an MAPD)
  4. Individual is 70 years old, had a Medicare Supplement for 5 Years – switched to an MAPD for the 1st time January 1st, 2014 – they choose to stay with the same MAPD carrier for 2015 – will they have a guarantee issue opportunity – answer – yes – we extend the guarantee issue window an additional 12 months if the member exits during the Annual Disenrollment Period, or exits due to a Special Election Period or exits due to the Annual Disenrollment Period for 2016.

 

These rules are very complex.  Do NOT rely on what you read on the Internet.  Double check!!!  Email us and include all the details and actual documents or screen shots.

 

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