Part 1 of our series went over what the different Medicare Supplements (Medigap plans) cover and how they work with Original Medicare.
In Part 2 of our series we are going to discuss the different enrollment periods for Medicare supplements as well as some of the underwriting criteria major carriers use in pricing their plans. Remember, in order to enroll into a Medicare Supplement policy, beneficiaries must have Medicare Parts A and B.
Open enrollment for Medicare Supplements is the 6 months following a beneficiaries Part B effective date and they are 65 or older. No health questions asked. Full commission paid according to contracted rates.
Underwritten policies can be issued at any time after the open enrollment period and beneficiaries are able to pass underwriting questions. Some policies have relaxed underwriting for a higher premium. Full commissions paid according to contracted rates.
Underwriting guidelines vary from carrier to carrier. Some carriers allow diabetics with no issues and other carriers will not issue policies at all for diabetics. Almost all Medicare Supplement carriers have a “prohibited prescriptions” list that tells you the application will be declined if a member takes the medication on the list for a specific condition. Some carriers include this list in every kit they send out.
Guaranteed issue. According to federal guidelines, carriers must issue a Medigap Plan A, B, C, F, K, or L that’s sold by any insurance company in the state under the following conditions;
- A beneficiaries’ current Medicare Advantage plan is leaving the area either due to financial reasons or is no longer going to offer that plan.
- During a Medicare Advantage members 12-month trial period
- Beneficiaries’ employer group plan that pays after Medicare is ending. This includes retiree and COBRA coverage
- Beneficiaries leave a Medigap or Medicare Advantage plan because the company hasn’t followed the rules
- Most states allow new move-ins a guarantee issue period for the first 63 days they are in a new service area.
Remember that some carriers will pay reduced or no commission on Guarantee issue business. Always do the right thing for your client but do it knowingly. Sometimes a client can still pass underwriting which allows you to get paid your full commission. Also, remember the plan letters listed above have Guarantee issue according to Federal guidelines (A, B, C, F, K and L). United Health Care also has guaranteed issue into the Plan N in many states. (At a reduced commission of course)
Medicare Supplements for Beneficiaries under age 65. Not all states require Medigap plans to cover beneficiaries under age 65. In some cases states may only require carriers to offer certain plans for those under age 65 or cover certain conditions such as ESRD. In all cases, under 65 policies are more expensive than a regular Medigap policy since carriers know the beneficiaries will be using more benefits than those over 65 on original Medicare.
Contact us today to get contracted with the highest rated carriers in your area. Many plans are only competitive in certain zip codes so don’t be fooled by all their hype. Let us help you with all of your Medicare Supplement contracting needs.