Medi Gap plan – guaranteed issue
if your Medicare Advantage Plan offers less benefits or raises premium
CA Insurance Code §10192.12 (D) (i) The Medicare Advantage plan in which the individual is enrolled reduces any of its benefits or increases the amount of cost sharing or premium or discontinues for other than good cause relating to quality of care its relationship or contract under the plan with a provider who is currently furnishing services to the individual. An individual shall be eligible under this subparagraph for a Medicare supplement policy issued by the same issuer through which the individual was enrolled at the time the reduction, increase, or discontinuance described above occurs or, commencing January 1, 2007, for one issued by a subsidiary of the parent company of that issuer or by a network that contracts with the parent company of that issuer. If no Medicare supplement policy is available to the individual from the same issuer, a subsidiary of the parent company of the issuer, or a network that contracts with the parent company of the issuer, the individual shall be eligible for a Medicare supplement policy pursuant to paragraph (1) of subdivision (e) issued by any issuer, if the Medicare Advantage plan in which the individual is enrolled does any of the following:
(I) Increases the premium by 15 percent or more.
(II) Increases physician, hospital, or drug copayments by 15 percent or more.
(III) Reduces any benefits under the plan.
(IV) Discontinues, for other than good cause relating to quality of care, its relationship or contract under the plan with a provider who is currently furnishing services to the individual.
(ii) Enrollment in a Medicare supplement policy from an issuer unaffiliated with the issuer of the Medicare Advantage plan in which the individual is enrolled shall be permitted only during the annual election period for a Medicare Advantage plan, except where the Medicare Advantage plan has discontinued its relationship with a provider currently furnishing services to the individual. Nothing in this section shall be construed to authorize an individual to enroll in a group Medicare supplement policy if the individual does not meet the eligibility requirements for the group.
I don’t see that the Federal Law has this rule.
AARP – Have us or your agent review bullet points 7 & 8 in confidential agent manual.
This is just a summary of the most common ways you can get a Medi Gap plan without having to answer health questions.
- Enrolled in Medicare and are age 65 or older; or New to Medicare, are age 64 or younger, and do not have end-stage renal disease
- You enrolled with A Medicare Advantage Plan and the plan is being terminated;
- terminated from any employer-sponsored health plan,
- moved outside the plan’s service area.
- disenrolled from the plan or program within twelve (12) months of the effective date of that enrollment.
- You terminated enrollment in a Medicare Supplement plan and subsequently enrolled, for the first time, in any of the following:
• A Medicare Advantage Plan;
- MAPD Trial Privileges #02110 Medi-Gap Guide
- The company substantially violated a material provision of the contract; or
- The company or its agent materially misrepresented a provision of the plan in marketing the contract to you.
- You enrolled in a Blue Shield Medicare Advantage Plan, and Blue Shield either:
Reduced any of its benefits;
Increased the amount of cost-sharing or premium;
- You are no longer eligible for Medi-Cal benefits.
- Birthday Rule
Get more detail at:
- Birthday Rule
- Loss of Employer Coverage
- MAPD Trial Period – Come back to Medicare and Medi-Gap
- Medical Questions – Underwriting – If not in Guaranteed Issue Period?
- Medicare Advantage Reduces Benefits, Co Pays, increase in premium
- Turn Age 65
On some pages you can Scroll down for our cut & paste of the ACTUAL CA Law
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Related Pages in Guaranteed Acceptance – Medi-Gap – Supplemental Plans Section
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