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Life Health > Health Insurance > Medicare Planning

FAQ: Medicare PDP Termination

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An agent from Portage, WI asks…

Q: Does a standalone PDP termination/non-renewal trigger a guaranteed issue right for a Medicare supplement plan? I’ve found various answers, none of which are very conclusive. I have seen some documentation that states that any plan that is under contract with Medicare that is termed/non-renewed triggers a guaranteed issue right for Medigap plans. I have also seen documentation that, in states where Medigap plans are not guaranteed renewable, any loss of Medigap (involuntary) will trigger an SEP for Medicare plans, including PDPs. Is this true?

A: Medicare is perceived to be very confusing, although it really is quite simple when compared to other insurance products. The simple answer to this question is no. PDP plans have absolutely nothing to do with Part D of Medicare. However, the chance to pick up new Medicare supplement clients exists when you assist a Medicare beneficiary with their Part D decision. Part D plans may not pay much commission, but they open the door of trust and will prove your Medicare expertise, earning you new Med supp business and potentially other insurance products in the process of solving the Part D riddle. Do not underestimate the power of the PDP decision!

If the terminating plan is a Medicare Advantage plan with prescription drug coverage (MAPD for short), it certainly will trigger a guarantee issue Med supp provision. Really, the health portion (not the prescription portion) is what triggers the guaranteed issue, which may be one of the following Med supp plans: A, B, C, F, K, or L.

As to whether Medigap loss triggers a special election period, it depends on the situation, the state, and the products approved in that state. To clarify, there is not any SEP for Med supps, which may be purchased all year long.

Our Medicare expert is Mike Smith, president of The Brokerage Inc. He can be reached at [email protected] or 469-635-6703.

If you would like to be considered for our Medicare FAQ expert panel to answer frequently asked questions, email associate editor Heather Trese.

Do you have a Medicare question that you would like answered? Email us and let us know! Please put “Medicare FAQ” in the subject line.


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