Not in open enrollment age, cancer treatment- is it possible to get Medigap?

[jacklee111]

So, my mothers' 69 and been working simply to have additional coverage for my father who's 78. He's had various cancers throughout the past few years, and has a list of pre-existing conditions.

He has medicare A/B, and my mothers insurance from her work covers pretty much everything else- so luckily the medical bills out of pocket have been manageable.

As my mother's work is demanding on her, and i'd like her to actually enjoy her retirement, I'm looking at various options to make up for the loss of her primary insurance. Medigap looks to be be the best deal- F to be specific. However, i'm curious as to how the rules work for enrollment for

a) mother since she's 69 - is there a stipulation that open enrollment is allowed for people who are coming off of work and won't have employer sponsored plan?

b) Father- since he's 78 and has pre-existing conditions, will there also be some stipulation about being under my mothers plan they have to accept?

I'm pretty sure my mother won't' have issue getting medigap F for herself (even if it's not through mandated open enrollment) since she's healthy. I'm worried that my father won't be able to get Medigap.

am i missing any other plans out there to help them?

 

[Mack]

So, my mothers' 69 and been working simply to have additional coverage for my father who's 78. He's had various cancers throughout the past few years, and has a list of pre-existing conditions.

He has medicare A/B, and my mothers insurance from her work covers pretty much everything else- so luckily the medical bills out of pocket have been manageable.

As my mother's work is demanding on her, and i'd like her to actually enjoy her retirement, I'm looking at various options to make up for the loss of her primary insurance. Medigap looks to be be the best deal- F to be specific. However, i'm curious as to how the rules work for enrollment for

a) mother since she's 69 - is there a stipulation that open enrollment is allowed for people who are coming off of work and won't have employer sponsored plan?

b) Father- since he's 78 and has pre-existing conditions, will there also be some stipulation about being under my mothers plan they have to accept?

I'm pretty sure my mother won't' have issue getting medigap F for herself (even if it's not through mandated open enrollment) since she's healthy. I'm worried that my father won't be able to get Medigap.

am i missing any other plans out there to help them?

Welcome to MyMedicareForum.com.

The best advice I can give you is to talk to a company that sells Medigap, it doesn't cost anything to talk and since they deal with similar issues every day they will be able to advise you. An easy to get a list of companies that provide Medigap for your location is with the Medicare.gov plan finder located at:

http://www.medicare.gov/find-a-plan/questions/medigap-home.aspx

I would think there will be a problem getting Medigap for your Dad, or at least a problem getting any type of affordable rate, however that is just my guess, as a lay person, so don't rely on my speculation.

Good luck and please come back and share your results as I am sure there are others in your situation.

 

[SeniorAvocate]

On page 68 of the Medicare and You booklet, it says "If you have group health coverage based on your (or you're spouses) current employment, you're Medigap open enrollment period will start when you sign up for part B."
As soon as your mother signs up for her Medicare part be it will be as if she is turning 65 and will be eligible to purchase a medigap policy, without worrying about pre-existing conditions, guaranteed issue. Unfortunatley your father would not qualify, since he has been on parts A and B. The good side to this is that he is not in an advantage plan, they can actually withhold services due to non payment, force him to pre pay deductibles for procedures. With just parts A&B, services can't be refused, but you're still responsible for the 20% of the approved costs, plus 15% of the approved in excess charges.

 

[christweedy]

So, my mothers' 69 and been working simply to have additional coverage for my father who's 78. He's had various cancers throughout the past few years, and has a list of pre-existing conditions.

He has medicare A/B, and my mothers insurance from her work covers pretty much everything else- so luckily the medical bills out of pocket have been manageable.

As my mother's work is demanding on her, and i'd like her to actually enjoy her retirement, I'm looking at various options to make up for the loss of her primary insurance. Medigap looks to be be the best deal- F to be specific. However, i'm curious as to how the rules work for enrollment for

a) mother since she's 69 - is there a stipulation that open enrollment is allowed for people who are coming off of work and won't have employer sponsored plan?

b) Father- since he's 78 and has pre-existing conditions, will there also be some stipulation about being under my mothers plan they have to accept?

I'm pretty sure my mother won't' have issue getting medigap F for herself (even if it's not through mandated open enrollment) since she's healthy. I'm worried that my father won't be able to get Medigap.

am i missing any other plans out there to help them?

Hey there jacklee111,

I just happened to stumble upon your post today and thought I would comment. When someone is covered under an employer coverage and that coverage terminates involuntarily, they have guaranteed issue rights into a Plan A,B,C, or F Medigap Policy. This holds true for their spouse as well. You will just need to supply proof of termination to the Medigap carrier. Also, in this situation the Medigap carrier cannot impose any pre-existing conditions or waiting periods. The same situation also applies for their Part D coverage if the drug coverage they had through her employer is deemed Creditable Coverage. This simply means that it is as good or better than Medicare Part D coverage. You can get confirmation of this by talking to your mother's employers HR person.

Hope that helps!

 

[mattspits]

The key there would be "involuntarily". It appears that mom is just retiring which would be voluntary not involuntary. Any medigap company would fight that. Especially if they new dad had cancer!

So, my mothers' 69 and been working simply to have additional coverage for my father who's 78. He's had various cancers throughout the past few years, and has a list of pre-existing conditions.

He has medicare A/B, and my mothers insurance from her work covers pretty much everything else- so luckily the medical bills out of pocket have been manageable.

As my mother's work is demanding on her, and i'd like her to actually enjoy her retirement, I'm looking at various options to make up for the loss of her primary insurance. Medigap looks to be be the best deal- F to be specific. However, i'm curious as to how the rules work for enrollment for

a) mother since she's 69 - is there a stipulation that open enrollment is allowed for people who are coming off of work and won't have employer sponsored plan?

b) Father- since he's 78 and has pre-existing conditions, will there also be some stipulation about being under my mothers plan they have to accept?

I'm pretty sure my mother won't' have issue getting medigap F for herself (even if it's not through mandated open enrollment) since she's healthy. I'm worried that my father won't be able to get Medigap.

am i missing any other plans out there to help them?

Hey there jacklee111,

I just happened to stumble upon your post today and thought I would comment. When someone is covered under an employer coverage and that coverage terminates involuntarily, they have guaranteed issue rights into a Plan A,B,C, or F Medigap Policy. This holds true for their spouse as well. You will just need to supply proof of termination to the Medigap carrier. Also, in this situation the Medigap carrier cannot impose any pre-existing conditions or waiting periods. The same situation also applies for their Part D coverage if the drug coverage they had through her employer is deemed Creditable Coverage. This simply means that it is as good or better than Medicare Part D coverage. You can get confirmation of this by talking to your mother's employers HR person.

Hope that helps!

 

[SeniorAvocate]

Wow, there are a lot of informed and intelligent people commenting here, it makes me smile. The rules are kind of quirky, if the insurance company cancels your moms policy, and gives your mom a letter saying so, it's like a golden ticket that allows your parents 63 days to pick up a new policy, medigap plan F if they want, without answering any medical questions, and it being guaranteed issued.
If your mom just retires, she would have to sign up for Medicare part B, and she would then have 6 months to pick up a guaranteed issue medigap policy. After that she would have to medically qualify, and it would be up to the insurance company. Even arthritis can disqualify you. For your dad, I won't hurt to apply, but the insurance company would make him answer the health questions. He may get past the questions if the diagnosis and treatments were several years in the past. If money is a big problem, Medicaid may be an option for him, Medicaid would work as a suppliment, but he would have to spend down his assets. Best talk to a Bankers Life agent, or BCBS agent (if you don't plan on Moving)

 

[christweedy]

jacklee111,

Much of your mother's situation does have to do with her Part B enrollment. If she hasn't enrolled yet, she will get Guaranteed Issue rights into a Medicare Supplement via her Open Enrollment. Open Enrollment begins as soon as you are 65 years old and enrolled into Part B. It begins the month both of those stipulations are met and lasts for six months. Your father will also receive Guaranteed Issue rights because his termination by the company was/will be involuntary. That is, HE didn't retire or chose to leave the employer.

The key there would be "involuntarily". It appears that mom is just retiring which would be voluntary not involuntary. Any medigap company would fight that. Especially if they new dad had cancer!

So, my mothers' 69 and been working simply to have additional coverage for my father who's 78. He's had various cancers throughout the past few years, and has a list of pre-existing conditions.

He has medicare A/B, and my mothers insurance from her work covers pretty much everything else- so luckily the medical bills out of pocket have been manageable.

As my mother's work is demanding on her, and i'd like her to actually enjoy her retirement, I'm looking at various options to make up for the loss of her primary insurance. Medigap looks to be be the best deal- F to be specific. However, i'm curious as to how the rules work for enrollment for

a) mother since she's 69 - is there a stipulation that open enrollment is allowed for people who are coming off of work and won't have employer sponsored plan?

b) Father- since he's 78 and has pre-existing conditions, will there also be some stipulation about being under my mothers plan they have to accept?

I'm pretty sure my mother won't' have issue getting medigap F for herself (even if it's not through mandated open enrollment) since she's healthy. I'm worried that my father won't be able to get Medigap.

am i missing any other plans out there to help them?

Hey there jacklee111,

I just happened to stumble upon your post today and thought I would comment. When someone is covered under an employer coverage and that coverage terminates involuntarily, they have guaranteed issue rights into a Plan A,B,C, or F Medigap Policy. This holds true for their spouse as well. You will just need to supply proof of termination to the Medigap carrier. Also, in this situation the Medigap carrier cannot impose any pre-existing conditions or waiting periods. The same situation also applies for their Part D coverage if the drug coverage they had through her employer is deemed Creditable Coverage. This simply means that it is as good or better than Medicare Part D coverage. You can get confirmation of this by talking to your mother's employers HR person.

Hope that helps!

---

Wow, there are a lot of informed and intelligent people commenting here, it makes me smile. The rules are kind of quirky, if the insurance company cancels your moms policy, and gives your mom a letter saying so, it's like a golden ticket that allows your parents 63 days to pick up a new policy, medigap plan F if they want, without answering any medical questions, and it being guaranteed issued.
If your mom just retires, she would have to sign up for Medicare part B, and she would then have 6 months to pick up a guaranteed issue medigap policy. After that she would have to medically qualify, and it would be up to the insurance company. Even arthritis can disqualify you. For your dad, I won't hurt to apply, but the insurance company would make him answer the health questions. He may get past the questions if the diagnosis and treatments were several years in the past. If money is a big problem, Medicaid may be an option for him, Medicaid would work as a suppliment, but he would have to spend down his assets. Best talk to a Bankers Life agent, or BCBS agent (if you don't plan on Moving)

I would shy away from a Bankers Life agent. Bankers Life is captive company, which means that their agents can only offer Bankers Life products. You are always best served by a broker that can represent multiple companies. After all, you want someone with YOUR best interests in mind... not just what his/her company sells. BCBS can be a good option, but they are typically not as competitive in the Medicare market. Many of the most competitive Medicare Supplement companies out there are ones that you've heard less about: Mutual of Omaha, Central States Indemnity, and Bankers Fidelity for example.