Guaranteed Issue Considerations

This post also covers Guaranteed Issue circumstances and the impact that has on your commissions. It is very important to start with this publication.. learn it! Choosing a MediGap policy. (Section 3 on Page 21) A Guarantee Issue situation means that someone has had a life change and is, therefore, entitled to a specific plan without any health underwriting. Guarantee Issue is different than Open Enrollment. Open Enrollment is also known as the Initial Election Period that someone is entitled to for the first 3 months after starting Part B (for Medicare Advantage plans) or 6 months after starting on Part B where Medicare Supplements are open enrollment. Open Enrollment (their IEP) entitles the person to ANY plan available in the market. Any Medicare Advantage plan or any Medicare Supplement plan letter. Guarantee Issue situations also allow for any Medicare Advantage plan, but only CERTAIN Medicare Supplement plans. What plan they can buy, through Guarantee Issue, depends on when they were first eligible (or could have been eligible) for Medicare to start. If they were eligible for Medicare prior to MACRA's starting date (January 1, 2020), they can now buy plans: A, B, C, F as guarantee issue. Even if they are now 70, 80 years old, etc., if they were older than 65 before January 1, 2020, they will always be able to buy those plans as guarantee issue if they lose other coverage. Those are their G.I. plans. (Most choose Plan F as G.I.) If they turned 65 after January 1, 2020, their Guarantee Issue plans to choose from are: A, B, D, and G. (Most buy Plan G as G.I.) Remember that in most states and with most carriers, writing someone with a guarantee issue plan (G.I. because they've lost other coverage) is a non-commisionable sale where you may not make any money on that sale. Click on the image to enlarge it: The question often is: Should you use a G.I. Plan (F or G, depending on when they turned 65) for someone if they are healthy and could qualify for a better plan for them, like Plan N? That question is covered here (must watch). New: Easy guarantee issue Matrix for Medicare Supplements from Medicare.gov - Click Here You may want to save this document to your computer to show clients while on a screen share or send to them during the enrollment process. It helps to prove that "all Medicare Supplement plans are the same" and makes several references to the fact that they can get a better price by shopping the market. It tells them to call each insurance company.. or you could offer to do it for them instantly at no charge! This guide has mostly good information with a few exceptions. It is imperative that all agents consume this guide for general knowledge, as it really answers the most frequently asked questions from clients about changing their Medicare Supplement policy. Choosing a MediGap Policy In the guide, it says that when a senior decides to change to another Medigap (Medicare supplement) policy, they should keep the old policy along with the new policy for 30 days. It specifically says that they should pay both premiums for one month. Not only is this wrong advice, it is illegal to have two Medicare supplement policies at once. It even states this in another part of the guide. The right answer is that they should not keep paying on two policies, not even for one month. True, they have a 30 day free look provision to examine the new policy and return it for a refund from the new carrier if they do not want it. What is also true is that the old carrier will take them back within 30 days if they want their old policy back. They need to know that this protection does exist. Mutual of Omaha and their subsidiaries actually tell the clients this when they call in to cancel one of their policies. They hope that there might be a chance to actually get that client back if there are problems with the new insurer. Another area that is not accurate enough is the description of Guarantee Issue rights. If a person is cancelling their employer's group insurance because the cost is way too high, in order to get a Medicare supplement plan, sometimes they will have guaranteed issue for a voluntary cancellation, and sometimes they will not - depending on the state. This very important, state-specific guarantee issue information is best found on the Mutual of Omaha Underwriting Guide. Here, I've singled out the pages that address the guarantee issue rights where the state-specific guidelines are used. You will want to print and keep this as a reference: Guarantee Issue Rules As mentioned in the April 12, 2013 webinar, the Mutual of Omaha Underwriting Guide for Medicare supplements is a great, overall guide to underwriting for Medicare Supplements. It is a guide that you will want to have saved somewhere for easy access, specifically dealing with someone with Diabetes, which is more and more prevalent each year. Mutual, United of Omaha, United World, and Omaha Insurance Company, as well as their affiliated companies like GPM Life, Gerber Life, and Woodmen, all use this same criteria when dealing with Diabetics, etc. Here is the entire Mutual/OIC underwriting guide as of 2013: Mutual Underwriting Guide Often, we will share with seniors what the rates are in their area, only to find that they are still on an employer retiree plan. Digging a little deeper, we sometimes find that they are paying nearly $1,000 per month on their employer plan that has network restrictions, co-payments and deductibles still. They just did not know that they could take part in a Medicare Supplement for under $200 per month. In such cases, it is important to make sure that they are on Medicare Part A and Medicare Part B. Sometimes, they will not sign up for Part B of Medicare because the employer plan always took care of doctor bills. That's OK, as long as they now activate Part B by calling the Social Security office. This, too, gives them another guarantee issue opportunity because they're starting Part B for the first time. If they already had Part A and Part B, and want to leave their employer group plan voluntarily, just make sure using the guide above, that they will qualify for guarantee issue. Guarantee issue only covers some Medicare Supplement plans, like Plans C and F. Plan G will always require the underwriting questions. This is a good way to go (Plan G or N) because it provides better value for their money AND because it will be fully commissionable to you as a sale. Many companies have reduced or almost completely eliminated commissions for guarantee issue situations, such as a person leaving their employer group plan and exercising their right to a G.I. Med Supp policy. Many carriers only pay a single, non-recurring payment of $25 commission. So, even if the opportunity does exist for them to qualify for a guarantee issue policy on Plan F (or G after 1/1/20), for instance, it is in their best interest, as well as yours, to see if their health would qualify them for a better value plan, like Plan N first. They're already used to deductibles, so it is a much easier concept for them to understand the value of paying their own deductible with Plan N. Here some examples from companies on what they will pay for "Guaranteed Issue cases". Note, if someone is just now joining Medicare Part B, that is considered Open Enrollment, and full commission. These commissions listed, though, are for those losing employer coverage (already had Part B), losing a Medicare Advantage plan, etc: Aetna, as of 2017: .75% on Guarantee Issue ARLIC / CIGNA: 2% Commission for Guaranteed Issue Loyal American: 2% Commission for Guaranteed Issue Combined: $25 one-time commission for Guaranteed Issue Sentinel Life: $25 one-time commission for Guaranteed Issue New Era Life: $25 one-time commission for Guaranteed Issue Stonebridge Life: 2% - 5.5%, depending on state for Guaranteed Issue Mutual of Omaha: Usually pays less than half commission for Guaranteed Issue Medico: FULL COMMISSION ON GUARANTEED ISSUE) in CO, IA, MI, OR, PA, SC, TN, (MO, if replacing) Medico: $25 one-time commission for Guaranteed Issue (All other not listed above states) Oxford Life: As of 8/1/15 only pays 20% of the normal commission rate for G.I. cases The following states will not be affected by the commission changes: CO, CT, MA, MO, NY, OH, SC, TN, VT & WA. Other helpful documents: http://www.medicareinteractive.org/uploadedDocuments/mi_extra/SEP-Chart.pdf Need contracting? See the left side of the page here.

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