Neighbor lost insurance coverage!

[RSKY]

Good advice. If he could be declared incompetent at the time he switched that could save him.

That is the same that I was told by somebody more knowledgeable on the subject than anyone else I know.

Just to be clear, I would guess it was an Advantage plan, and not a Supplement Plan. There is a big difference and I don't think a Supplement plan would have caused this.

Don't know what kind of plan it was. Just that he had seen it on TV. But the main insurer is Medicare, the supplemental is from the company we worked for.

Unless they have totally screwed up Obamacare, insurance companies are required to cover pre-existing conditions.

He said it would not cover his preexisting conditions. How he knows that and how long this has been going on I don't know.

Curious what would be considered screwing up the travesty that was presented as "the Affordable Care Act". It was a disaster from the get go.

Everybody and I mean everybody that I worked with had their rates triple to quadruple under obamercare. The only ones who came out ahead on it were the ones who had never worked, never intended to work, and wouldn't work if you offered them a good job.

I am going to try to stay as far away from this situation as I can. The man has an older brother (worthless), an older sister (in bad health), and three sons who will have to straighten this out. I posted this to tell everybody to watch out for their parents and siblings who might not be thinking clearly because of age or illness.

I hate it because this hard working, honest guy is gonna get screwed over because he just does not understand anymore.

RSKY

 

[Larry Caldwell]

I'm fortunate that my wife was in heath insurance for a while. She used to travel all over doing billing training for the Blues. Your friend needs to contact county senior and disable services and get a case advocate to clean up his mess. His story goes on hundreds of times a day. Death by a salesman. He needs to get on this, because reversing it after 30 days gets a lot more complicated.

 

[oosik]

I have post employment insurance from my government job. It was explained to me and I had to sign an acknowledgement form - drop this gov paid policy and you can NEVER get back on.

 

[KennyG]

This sounds like a really bad situation, but no one should take the information provided as guidance for what they should do. There must be a lot going on here we don't know.

Medicare covers all pre-existing conditions. Employer provided plans, if they exist, are secondary and cover (within their scope) only things Medicare doesn't like some co-pays. Similarly, a Supplemental plan does the same thing. Supplemental plans may not cover pre-existing conditions for some period of time, but the basic Medicare is still in place.

Advantage plans replace Medicare with an HMO type of coverage so you don't have Medicare anymore, but they are required to cover pre-existing conditions. The catch is that they restrict where you can be treated and may deny coverage if they say it's not medically necessary.

There is certainly something else going on and the person needs an advocate who understands the situation.

 

[Oaktree]

Advantage plans replace Medicare with an HMO type of coverage so you don't have Medicare anymore, but they are required to cover pre-existing conditions. The catch is that they restrict where you can be treated and may deny coverage if they say it's not medically necessary.

There is certainly something else going on and the person needs an advocate who understands the situation.

Well, there's a lot that Medicare doesn't cover either. It's one strong point is that it's accepted pretty much everywhere. I don't mind being limited to doctors who are part of the plan...every employer I've had in the last 40 years had some sort of HMO health plan, so it was nothing new.
The advantage plan my wife & I had is being discontinued as of 12/31 so we had to find a new one. Trying to compare plans on the gov't website will make your head explode, especially when taking prescription coverage into account!

Agree that there's more to the OP's friend's situation than meets the eye.

 

[kthompson]

I have been active in health insurance for many years. From individual plans of the late 80's to small group and all the plans that have been mentioned here.

I do ask a person who has retired from a plan with retiree coverage what happens IF THEY enroll in other coverage. We have few employers here who have such plans but have help one or two come off of their employer plans as they really were crappy and very expensive. No better than plans open to the public for even about 10% of the premium of their old employer plan's cost to them. That being said have had some strongly recommend to them to keep their plan and never consider replacing it.

A Medicare Advantage Plan CAN NOT TERMINATE a Medicare Supplement. ONLY THE INSURED CAN. Now if he did enroll in Medicare Advantage Plan it can move his Medicare Coverage to the Medicare Advantage Plan. If that has happened, it is not hard to correct. First, he needs to know how he qualified to be enrolled at that time. We are in the Annual Enrollment Period or AEP. Those plans are normally effective Jan 1st. If that is what happened, then tell him to make application for a PDP or prescription drug plan and it will terminate that MAPD plan.

If that is not what happened and he needs more help: Call CMS, Medicare fraud on what happened. They should be able to manually correct the situation. Also call his state department of insurance. They will have a customer complaint department and they can act fast on such. They have more power than many think.

I am amazed at the junk being told both in print and the air ways. Sadly, they are normally legal, but people want the moon and are willing to stop thinking when they hear how great the golden eggs are. In my area there is NO plan that matches what is being told they can get to the extent they are saying. Just not true. Their cover is they leave it open talking about the POSSIBLE benefit and call to see if they are eligible for it or if there is a plan with that coverage in their zip code.

By Federal Law most likely the law was broken with this if it was a Medicare Advantage Plan. At the same time a person who has a working brain (I fully realize there those who don't have the ability to make such decisions due to health or such issues.) would ever pick up a phone and call to who knows where to speak to a person who is only seasonal to trust them in their recommendation on such an important part of their life. Yet they do it over and over by the thousands, every year.

But, if he had what is called "Qualified Coverage" and lost it with no break in his coverage another Qualified Plan cannot have a preexisting condition on him.

Be sure to help him file a formal complaint with all the agencies he can.

First call the company his new coverage is with and them tell them you need a USA customer service rep who can help you with FRAUD. If possible, record these calls.

 

[oosik]

I am surprised that folks think the "insurance sales game" would be any different from say - the "auto sales game" or the "land sales game". All three are supposedly regulated by government regulations. All three are there to part you and your money. A whole lot of folks are just too trusting.

 

[Larry Caldwell]

I am surprised that folks think the "insurance sales game" would be any different from say - the "auto sales game" or the "land sales game". All three are supposedly regulated by government regulations. All three are there to part you and your money. A whole lot of folks are just too trusting.

The US health care system has resulted in a labyrinth of options, rules, and regulations. It takes an expert to weave their way through the system, and way too many people get totally screwed. In fact, we are all getting screwed, because we pay $1 trillion a year for health care in the US and a lot of people still get shafted into bankruptcy, illness, and death. We all know people who avoid going to the doctor because they can't afford the co-pay, even if they have insurance.

The sensible thing would be to end our for-profit health care system, but good luck getting that one past the lobbyists.

 

[dmccarty]

....

If that is not what happened and he needs more help: Call CMS, Medicare fraud on what happened. They should be able to manually correct the situation. Also call his state department of insurance. They will have a customer complaint department and they can act fast on such. They have more power than many think.
...

What he said.

Call the state insurance department.

Years ago a coworker had his house insurance canceled for no good reason. He had no claims, did not live in a flood zone or high wind zone but they canceled him. I suggested he call the state insurance commission, which he did, and his policy was not canceled. If I remember right, he then went and found a new insurance company. Call the state to see if they can help out.

 

[fruitcakesa]

I would be leery about buying anything advertised on TV especially something as critical as health insurance.
We switched from an advantage plan to medicare supplement after speaking to my insurance agent who laid out all the pitfalls and plusses of both type plans.
While the advantage plan had the "advantage" of having $0 premiums, its limitation and restrictions were so onerous that paying for a Plan N policy seemed like a bargain.
We are both in good health so don't use much health care or use any prescriptions but having a solid plan brings some peace of mind.