CA Guidelines to determine Residency
CA Guidelines to determine Residency

FYI Covered CA accepted documents for proof of CA Residency – Page 3

Evidence - Residency
MAPD Enrollment Rules
Travel Insurance
Travel Medical Insurance
Blue Cross FULL PPO MAPD Policy
Specimen Evidence of Coverage

Hi Steve,

My name is R. V. & I turned 65 on October 6, 2015.

I have both Medicare Part A Hospital & B Doctor Visits.

My Part B started April 1, 2016 & I know that in order to have a Guaranteed issue OR be in Initial Enrollment period I have to enroll within 6 Months from April 1st 2016 which gives me last date for initial enrollment of September 30, 2016.

***Yes that is correct.

I would like to get a Guaranteed Issue Medicare Supplement Plan ( Medigap ).

But my situation is unique.

I have been living in India for a long time due to family obligations etc. and I cannot be back in my last Resident state of Wisconsin before September 30, 2016. I have my household furniture etc. in a storage place in Wisconsin as well as my Bank accounts are in Wisconsin & I do all my transactions thru those banks. I also plan on coming back around Christmas or beginning of 2017. I do have friends in Wisconsin where my policy can be mailed.

***Sounds like you have residency to me.   I don’t find a definition in Blue Shield’s evidence of coverage.  Call me or a Wisconson agent to discuss further.

So here are some questions I have.

I want to take advantage of initial enrolment & I read some choices on internet but I am not sure if they are correct & so I decided to ask your professional opinion & sign up for Medicare Supplement plan. In My Medicare file the address is India & that is where I am getting my Medicare payment notices.

Can you tell me if I can sign up right now before September 30 , 2016 deadline & make auto bank payments as I am currently doing for Medicare Part B ?

***I believe so.

If yes which company would you recommend ?

***I’m not licensed outside of CA so I don’t really know the market there.  If you use this link, I get a referral fee from the licensed agent that will call you.  Also, the rates & benefits show up immediately.

I read on Medicare site that I have 60 days to enroll in Medicare Advantage (MAPD) Part C & Part D after I return to US

***Our page on Medicare Advantage Enrollment dates.  The citation is on page 7 of publication 11219.

changes-where-you-live

but do I have such an option for Supplement plan ? If yes can you give me info on that.

***See our Guaranteed Acceptance Page for Medi-Gap.  I really enjoy people that have done the research and ask intelligent and interesting questions.  Please note also, that some rules are Federal, I can help you with those and some rules are for California (only?). Situation # 5 on Blue Shield’s list is very close to your situation.

I checked via email with CA Health Care Advocacy SHIP (State Health Insurance Assistance Program) and they said no.  So did Blue Shield Broker support.

I also read that after I sign up for Medicare Advantage the first time, I can switch to Supplement plan within 12 months which I think is trial right but I am not sure.

***Yeah, something like that.  Read the guaranteed issue rights on our Medi-Gap page.

Situation 6 - Disenrollment 1st year
Situation 6 – Disenrollment 1st year

If that is true, do I have to sign up for Advantage plan immediately after I turn 65 or I can do that after I am back to US & within 60 days of my return by which time I will be 66 ?

***It says 2 months after you return.  That is for MAPD.  I will have to check on Medi-Gap.  Good complex question.

There may also be an issue of when you can disenroll from Medicare Advantage (MADP).   On the Medicare.Gov website, also publication 11219 page 5, it says to just call Medicare or your Health Plan. Some places list the time period only as January 1 through February 14 of each year.  What brought this to mind, is that agents and the companies can get in trouble if there are too many disenrollments.

Also would such a Guaranteed Issue right require me to answer Medical Questions when I want to switch to Supplement plan within 12 months window ?

***That’s the whole point of guaranteed issue, that you don’t have to answer medical questions, just show the guaranteed right.

I have not applied for my Social Security yet.

Going thru underwriting process is always an option but I don’t have much understanding of that.

***Take a look at a sample application and see what the questions are.  Different insurance companies ask different questions, here’s a sample from one of the more liberal companies.  This is NOT sales material and is informational only!

I do not smoke at all.

I guess I have given as much info about myself as possible so keeping in mind the deadline of September 30, 2016, what would you recommend that I can do right now to enroll in Medicare Supplement plan ?

***Let me research this more.

I would really appreciate any & all the help.

I am overseas & there is time difference so I can call you from 5 PM to 8 PM India time so accordingly please give me your time.

***Email is the best way to reach me, especially on complex questions that I have to research.

Thank You,

R V

**********

Hi Steve,

I sincerely appreciate your answers to each of my questions to the best of your knowledge which is pretty deep.

I will wait for your research on some complicated questions.

You deserve the referral fee & you have earned it & will recommend anyone who is looking for an honest agent with integrity.

Thank You Steve

Regards,

R V

 

*********

Hi Steve,

I hope you had a nice Weekend.

***Yes, thank you very much.

I spoke to an agent who is licensed to sell Anthem Blue Shield

***In CA Anthem is Blue Cross and Blue Shield is separate company.

for Wisconsin & gave all the info just as I gave you & made sure that he knows that I was living outside the country.

***We have to look up the defintion of residency…  see above.

He said you just need an address, He said even my Storage address is fine

***This IMHO is huge, to show residency!

but that is just a Po box address & he said that fine too. I asked him about my friends address & he said that is fine too. He was in a hurry to sign me up immediately & I said I will call him back.

Here are my concerns.

My Medicare Card has address in India & they mailed me the card in India.

***I don’t think that is an issue.  See the definition of residency above.

So would that something Blue Shield match when issuing the policy ?

***Medi-Gap plans do not have all the crazy rules that Medicare Advantage does.  Still the issue here is residency.

If not what if at a later stage when it comes to paying for medical services that I received & then Blue shield says well we are not going to because you were not living in Wisconsin when you signed up ? Who will be responsible then ? Me or the Agent ?

***I still think it’s all an issue of residency.  See above.  The agent is telling you the same think I am.  The difference is, that I looked up the exact laws on residency and it’s a gray area.  Another problem agents have is that when we go for training, it’s an insult to our intelligence and is full of hype and often lacks ethical values.   I’ve studied beyond the seminars and built the website…

I do not think that this gray area of residency is a “material matter” that the policy could be recinded for.

I’d say you are both responsible, but now I think you are getting me outside the realm of insurance and into law, where I can’t advise you as I’m not a licensed attorney.

Do I have a right to record the signing up conversation & will it protect me because agent made a mistake ?

***If you don’t trust mine and the agents definition of residency, then you just shouldn’t buy the plan.  My father and grandfather were in the business too and they taugh me that if a prospect asks too many questions, don’t sell him the policy.

Even if you call an Insurance Company direct, their inside sales staff will probably tell you the same thing.  If you want to cover yourself beyond comprehension, write a letter and include it with your application.   Please note that the companies often make mistakes and won’t own up…

I just let my contract go with Health Net, as there RSM Regional Sales Manager told me THREE times, that I couldn’t write a medi-gap plan for someone whose MAPD plan non renewed.  Even though  I emailed her the official proofs.   She even kept this up at a sales meeting and told the other agents there the same thing.   When my client complained to the CA Department of Insurance, HN denied responsiblity as they said they never received an application.  They didn’t mention anything about telling their agent that he would be wasting his time sending it in.

Also, I don’t think you can say the agent made a mistake.  You now know more about residency than 95% of agents and Regional Sales Managers.  In addition, by your question, you know about recision of policys for mistatement of material facts than most anyone in the sales force.

Second two other agents for two other companies said the same thing

***Exactly.  That’s what I’m telling you.  If it was easy, do you think it would take the State of CA 13 pages to determine resident status and how many pages of regulations and case law?

so in that case just to make sure that I am signing up within my initial enrollment period, can I sign up with more than one company & once I receive the confirmation & policy, can I cancel the other policies ?

***Why waste everyone’s time?

Of course I will lose the one month premium for extra policies.

***No, you could ask those to be cancelled…

Steve, I did try hard to find answers to these questions on internet but I couldn’t.

***The answer is that there is no answer.  California has 13 pages to determine residency.  If you want more, you will have to go to the law library.  Try these online legal resources.

Did you follow all the 33 links in this page that I gave you?

What is the term used in the insurance policy, application  and the law, live or residency?

I would be very grateful if you can enlighten me about these questions.

***Read the 13 pages on residency.

You might try your  State Health Insurance Assistance Program  – Wisconsion    CA   CA Health Care Advocates    If you do get more clarification – please post in comments below.

 

Thank You again Steve.

Regards,

R V

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