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Valued Social Butterfly

Re: Medigap Guaranteed Issue Confusion

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Message 1 of 6

Indianrock wrote:

It all worked out.   We had to supply forms to our new medigap provider showing both of us have been covered by employer insurance all along.   As far as being on part B while you have employer coverage through your spouse, I assumed it was like any other situation where a married couple have more than one medical insurance provider and the secondary is billed for any balance not covered by the primary.


So all you really wasted was her having to pay a few months of Part B premiums - which could add up because of the current rate of coverage.  Glad it worked out.

 

As to your other concern about other health insurance and Medicare - It depends on what your employer plan says -

The Medicare website covers a lot of stuff.  Here is the part that has the info which you are concerned about.

Medicare.gov - Should I get Part A and Part B

and

Medicare.gov - I Have Employer Coverage

 

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Gold Conversationalist

Re: Medigap Guaranteed Issue Confusion

421 Views
Message 2 of 6

It all worked out.   We had to supply forms to our new medigap provider showing both of us have been covered by employer insurance all along.   As far as being on part B while you have employer coverage through your spouse, I assumed it was like any other situation where a married couple have more than one medical insurance provider and the secondary is billed for any balance not covered by the primary.

Randy
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Recognized Social Butterfly

Re: Medigap Guaranteed Issue Confusion

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Message 3 of 6

Gail has precisely answered your Medicare question. As always she does a good job.

 

I’m going to throw this link in just for good measure.

 

https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/guaranteed-issue-rights-s...

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Valued Social Butterfly

Re: Medigap Guaranteed Issue Confusion

453 Views
Message 4 of 6

Indianrock wrote:
I think I've been laboring under a poor understanding of guaranteed issue.  There must be hundreds of thousands, perhaps millions, of spouses who retired, or never worked, but their partner ( typically husband) continued working past 65. ( my situation )
 
So the wife hits 65 and gets part A, continuing to have remaining coverage provided by husband's employer's insurance.   As the husband nears retirement, the wife gets Part B but not medigap.
 
Then she decides it's time to get medigap.  She can do it before the husband's retirement date or after, within 63 days.  If the husband's employer insurance ends when he retires ( typical ),  if she waits until then she would be able to get the statement from employer/insurance company that her coverage ended  --- HOWEVER, she would be exposed and have a gap in coverage until the medigap took effect.
 
If she gets the medigap prior to husband's retirement date, she can't get the "end of coverage letter," and apparently can't get guaranteed issue so might need underwriting, exams and possible issues with pre-existing conditions.  Makes no sense.  What makes sense to me is that if she gets her medigap prior to husband's retirement/end of coverage, she gets guaranteed issue and either needs nothing from the employer's health insurance company or would get  a letter of "active status" from that insurance company.

I think the problem is here in this situation is that she did not pick up a Medigap plan when she picked up Medicare Part B.

 

The Medicare website under the section entitled "When Can I buy Medigap?"

and under the special circumstances of employer or union coverage -

 

"If you have group health coverage through an employer or union because either you or your spouse is currently working, you may want to wait to enroll in Part B. Employer plans often provide coverage similar to Medigap, so you don't need a Medigap policy.

 

When your employer coverage ends, you'll get a chance to enroll in Part B without a late enrollment penalty. That means your Medigap open enrollment period will start when you're ready to take advantage of it. If you enrolled in Part B while you still had the employer coverage, your Medigap open enrollment period would start. Unless you bought a Medigap policy before you needed it, you’d miss your open enrollment period entirely."

 

Her coverage under your employer did not stop when she pick up Part B so why did she decide to start Part B ?  She could not use both.

Medicare assumes that when employer or union coverage ends that is when you pick up Part B and starts the clock on getting a Medigap under guaranteed issue.

 

Here's the link

https://www.medicare.gov/supplement-other-insurance/when-can-i-buy-medigap/when-can-i-buy-medigap.ht...

 

 

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Bronze Conversationalist

Re: Medigap Guaranteed Issue Confusion

466 Views
Message 5 of 6

You would make the effective date the 1st of the month after the employer health insurance is terminated, that would avoid the gap in coverage wouldn't it? 

Melissa Kay
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Gold Conversationalist

Medigap Guaranteed Issue Confusion

717 Views
Message 6 of 6
I think I've been laboring under a poor understanding of guaranteed issue.  There must be hundreds of thousands, perhaps millions, of spouses who retired, or never worked, but their partner ( typically husband) continued working past 65. ( my situation )
 
So the wife hits 65 and gets part A, continuing to have remaining coverage provided by husband's employer's insurance.   As the husband nears retirement, the wife gets Part B but not medigap.
 
Then she decides it's time to get medigap.  She can do it before the husband's retirement date or after, within 63 days.  If the husband's employer insurance ends when he retires ( typical ),  if she waits until then she would be able to get the statement from employer/insurance company that her coverage ended  --- HOWEVER, she would be exposed and have a gap in coverage until the medigap took effect.
 
If she gets the medigap prior to husband's retirement date, she can't get the "end of coverage letter," and apparently can't get guaranteed issue so might need underwriting, exams and possible issues with pre-existing conditions.  Makes no sense.  What makes sense to me is that if she gets her medigap prior to husband's retirement/end of coverage, she gets guaranteed issue and either needs nothing from the employer's health insurance company or would get  a letter of "active status" from that insurance company.
Randy
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