Mutual of Omaha has an article in this month’s “Mutual Matters” that lays out the scenarios in which a client would have guarantee issue rights for Medicare Supplements. It’s a good reminder during this time of year, especially with all the PFFS exits. There will be more Medicare Advantage members moving to or back to a Medicare Supplement this year.
The below section is pulled from the article. I hope it helps.
According to CMS, your client has guarantee issue rights if:
- Your client’s Medicare Advantage Plan leaves Medicare or stops providing care in the service area, or your client moves out of the plan’s service area.
- Your client has Original Medicare and an employer group health plan (including retiree or COBRA coverage) or union coverage that pays after Medicare pays and that plan ends (We extend this to people who voluntarily leave an employer-sponsored group health plan).
- Your client has Original Medicare and a Medicare SELECT policy and move out of the Medicare SELECT policy area.
- Your client’s Medigap insurance company goes bankrupt and he/she losses coverage, or the policy otherwise ends through no fault of your client.
- Your client leaves a Medicare Advantage Plan or drops a Medigap policy because the company hasn’t followed the rules, or misled them.
Things for agents to remember (this section is from me, not Mutual of Omaha):
- Some companies will not pay full commission on guarantee issue (GI) business. Most states require it, but some do not.
- Some companies will not advance commission on GI business. Typically companies will not advance on clients coming from a Medicare Advantage plan but will advance on Open Enrollment GI clients.
- Turn around time on application will be longer during this time of the year. Get your clients done early and set their expectations accordingly.
CMS’s 2010 Choosing a Medigap Policy: A Guide to Health Insurance for People with Medicare (…that’s a mouthful)
Starting on page 23, you can find a detailed explanation of the rights of Medicare beneficiaries.