Plan Advisors Blog

How to help a client who lost Medicaid eligibility

Posted by Lance Hoeltke on Fri, Jan 01, 2021 @ 04:21 PM

My Client Qualified for Medicaid…But What if They Lose It Later?

Any Medicare Sales Specialist who has serviced the dual-eligible population knows the flexibility given to low-income beneficiaries as it pertains to obtaining (or switching) coverage. But what happens when a beneficiary loses Medicaid eligibility? It’s important for brokers to have the loss of eligibility information to share with clients that are new to Medicaid so that the client can be prepared for future changes in their dual-eligible status.

What happens when a Medicare Advantage beneficiary loses Medicaid?

As it pertains to Medicare Advantage clients, most brokers are aware that losing Medicaid coverage triggers a Special Election Period.

Using SEP code MCD, the beneficiary has one opportunity to make an election within three months of the loss, or notification of the loss, whichever is later. The effective date for enrollments under this SEP is the first day of the month following receipt of the enrollment application.

What about Medicare Supplement? 

For clients new to Medicaid who formerly had a Medicare Supplement, they have a 24-month suspension period during which they can reinstitute their Medigap policy if they were to lose Medicaid benefits. The key here is that the beneficiary must request suspension of the Medigap policy within 90 days of the notification date of Medicaid eligibility.

Note that because recipients are often notified of Medicaid eligibility more than 90 days after the effective date, it is the notification date that is recognized as the starting point for the 90-day window.

Brokers that wish to research this topic further can read the full Program Memorandum HERE.

The following states allow beneficiaries a guarantee issue Medigap policy after the loss of Medicaid eligibility:

Refer to each state’s Medicaid office for specific guarantee issue time frames.