Medicare Answers: Loss of Medicaid

By Dwane McFerrin, Vice President, Medicare Solutions

  • Originally published November 19, 2014 , last updated September 17, 2015
Medicare Answers: Loss of Medicaid

An agent recently asked SMS's Dwane McFerrin about a client's options who wants to change to a Medigap plan from a Medicare Advantage plan.

Q. A prospective client is under 65, on Medicare due to disability. She just lost her Medicaid eligibility on Oct. 1. She is currently on a Medicare Advantage plan, but does not like it. Can she change to a Medigap plan for January 1? Will she have guaranteed enrollment due to the loss of her Medicaid? What are her options for Medigap plans, as there are health issues?

A. Medicare Supplements do not have a Special Election Period like Medicare Advantage plans. Also, Medicare Supplements do not have an Annual Election Period. Carrier underwriting rules vary and you’ll find BCBS organizations and/or AARP Med Supp typically with the most liberal underwriting rules, assuming an under-65 plan is available in the state. Look at the outlines of coverage, and if you see a rate for under 65, then you know a plan is available as is the case in Illinois. Remember that Med Supp plans are state-regulated, so some of the CMS guidelines for MA-PD guaranteed issue don’t apply to Med Supp.

For Plan F, a client losing group coverage or Medicare Advantage coverage can generate a guaranteed issue situation for 63 days. In researching the Illinois rules for Medicare Supplement guaranteed issue, I don’t find anything that suggests that the loss of Medicaid coverage will result in a guaranteed issue situation for Med Supp. The client would be guaranteed acceptance in another Medicare Advantage plan. Once the client gets to their 65th birth month, they will be eligible to apply for any Med Supp plan the carrier is offering in the state via a new open enrollment period.