Employer Retiree Medicare Advantage Termination Scenario

By | January 19, 2013

Joe lives in Illinois. Joe is 73 with COPD. Joe is retired from ACME manufacturing in Ohio.

The retirement package from ACME included an Anthem Medicare Supplement and Part D plan for all employees including Joe.

ACME decides plan is too expensive. ACME decides to switch to an Anthem Medicare Advantage plan for retirees effective 1-1-13.

ACME sends Joe a letter informing him of the change. Since Joe lives in Illinois they will not enroll him in the new Anthem Medicare Advantage plan.

Joe loses the letter but remembers something about having to make a change before 1-1-13. Joe calls BCBS and enrolls in a Medicare Advantage HMO.

Joe receives BCBS HMO information 1-10-13. As he goes through the information he realizes he has to use a Primary Care Physician. Joe has a doctor he likes and has been going to for 20+ years. Joe calls doctor. Doctor will not accept new plan. Joe searches around. Joe can find only 1 doctor that will accept plan. Joe doesn’t want to go to new doctor … wants his old doctor.

Joe wants a Medigap with a different Part D plan.

Joe enrolled in the BCBS Advantage plan. Does this nullify his GI for a Medigap?

The answer from the article is as follows:
My understanding is federal law requires that Medicare supplement and Medicare Select standardized plans A, B, C, F, K and L be guaranteed issue, without pre-existing condition exclusions, if you have Medicare and an employer group health plan (either primary or secondary to Medicare) terminates or ceases to provide all such supplemental health benefits.

The take away here is that Joe needed to find a plan for himself. Since he already had Medicare, he cannot be turned down for some of the Medigap Policies because of his COPD condition, since he had no control over his former employers actions.