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Special Medicare Supplement Guaranteed Issue Rule | California - YouTube
Channel: Christopher Duncan RICP庐
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hi today's video is about a little-known
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law unique to California regarding
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Medicare Advantage plans and receiving a
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guaranteed issue into a medicare
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supplement plan I'm Chris Duncan
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independent insurance broker and I help
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explain Medicare basics so Medicare
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beneficiaries know all of their Medicare
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choices our best of most common
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complement is when our clients refers to
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their friends and family and they tell
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them to talk to Chris because he is
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Medicare made clear or talk to Chris
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because he is Medicare made easy our
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clients consistently tell us we make
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this easy for them while watching this
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video if you find the information
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helpful please subscribe to our Channel
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and make a comment below
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like I said there is a little-known log
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unique to California about Medicare
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Advantage plans and qualifying for a
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guaranteed issue into a medicare
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supplement plan I don't know if it has
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an official name but I keep a bookmarked
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on my computer where it is on the state
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of california's legislative website and
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under california law it is under article
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6 medicare supplement policies i simply
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call it the 15% rule i do know that i
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help at least one desperate person a
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year that needs to use it i also get
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several calls per year from agents who
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are located all over the country who
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have a client here in california asking
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me if i know of any way to help them i
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have even got called from a
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vice-president of one of the largest
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medicare supplement providers in the
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united states asking me for help to help
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another agent and their client and like
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i said this is a little-known rule and
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why it can be so important to use
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professional agents that specialize in
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medicare because medicare has so many
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little rules and laws so here's the rule
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it states that if your Medicare
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Advantage plan has an increase in
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premium by 15 percent or more an
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increase in physician hospital or drug
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co-payments by 15 percent or more or
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reduces any benefits under the plan this
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means if a Medicare beneficiary has a
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Medicare Advantage plan in California
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and any of these conditions take place
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they have a guaranteed issue right into
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a Medicare supplement policy now for the
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sake of clarity Medicare defines a
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guaranteed issue on its website and the
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link is provided in the description
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below this
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also in the guide to buying a Medigap
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policy under guaranteed issue rights and
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I quote you have in certain situations
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when insurance companies are required by
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law to sell or offer you a Medigap
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policy and these situations any
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insurance company can't deny you a
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Medigap policy or place conditions on a
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Medigap policy such as exclusions for
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pre-existing conditions and can't charge
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you more for a Medigap policy because of
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past or present health problem unquote
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why is this important when a Medicare
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Advantage beneficiary has certain
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medical conditions or many different
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medical conditions they will likely not
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qualify it for a Medicare supplement
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plan a Medicare supplement has the right
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to ask medical questions underwrite and
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potentially deny coverage to an
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applicant that has had their part be in
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effect for six months or longer it is a
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very common belief amongst those on
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Medicare and many insurance agents that
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sell Medicare products but don't
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specialize in Medicare products that the
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annual enrollment period that occurs
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from October 15th to December 7th every
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year is the time for those that want to
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change their Medicare supplement and
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they may do so without having to answer
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any health questions whatsoever and
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cannot be denied coverage and the
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insurance company must cover
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pre-existing conditions the fact is the
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Medicare annual enrollment period has
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nothing to do with Medicare supplement
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plans the annual enrollment period is
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about electing or changing a Medicare
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Advantage Part C plan electing are
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changing a prescription drug plan Part B
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or dis enrolling from a Medicare
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Advantage plan and Riaan rolling back to
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Original Medicare and if a Medicare
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beneficiary would like to change their
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medicare supplement they may do so as
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many times as they like throughout the
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year whenever they want to but in almost
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every circumstance the company they are
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applying to for the Medicare supplement
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has the right to underwrite them and
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deny them coverage or accept and deny
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them coverage for pre-existing
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conditions for up to six months again
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why is this important every year I have
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several clients call during the annual
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enrollment period like to leave their
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Medicare Advantage plan
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turn to Original Medicare and purchase a
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Medicare supplement usually this isn't a
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problem I asked why and usually it is
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because they want to leave an HMO
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Medicare Advantage plan to return to a
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Medicare excuse me to return to Original
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Medicare to gain freedom to see any
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provider in the United States that
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accepts medicare assignment without
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referrals but inevitably at least once
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per year one client says something like
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I have contracted XYZ disease or a
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chronic condition and would like to
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return to Original Medicare get a
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Medicare supplement plan so I have
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access to more doctors I say that is not
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a problem returning to Original Medicare
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and Original Medicare will cover all
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your pre-existing conditions but the
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Medicare supplement company is in all
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likelihood going to deny you coverage
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and without a Medicare supplement the
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Medicare beneficiary is responsible for
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all co-pays coinsurance deductibles
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Medicare doesn't pay for and what the
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Medicare beneficiary is responsible for
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has no out-of-pocket limit I had two
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clients come to me last year that wanted
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to return to Original Medicare and get a
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Medicare supplement while having health
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conditions that the Medicare supplement
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companies would have denied them
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coverage they obviously didn't qualify
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for a guarantee issue through the normal
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guaranteed-issue rules most everyone
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knows about and one of the two was
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simple to find a 15 increase fifteen
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percent increase for in one of the
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co-pays or premiums I usually look at
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the drug cost first because that can be
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as easy as a generic drug that my client
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is taking going up from zero to one
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dollars this specific client had an
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increase in prescription drug costs on
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their plan but the second case it wasn't
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as easy over the last few years many
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Medicare Advantage coupling companies
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have been increasing benefits and
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lowering co-payments this is a good
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thing this Medicare Advantage member was
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on a plan that increased almost every
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benefit and decreased almost all of its
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co-payments I had to thoroughly go
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through the plan and I found the only
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increase in copay was with the ambulance
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benefit the copay went from two hundred
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dollars to two hundred and fifty dollars
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I found the 15% increase I needed to
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help my client qualify
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for a Medicare supplement
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guaranteed-issue and have all
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pre-existing conditions covered I was
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getting nervous I've always been able to
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find and increase pretty easily and I
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thought I was going to start having to
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look at the decreases if any and dental
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vision or hearing or reduction in gym
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membership benefits I have always been
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able to find some type of qualifier but
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finding the 15 percent increase or
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reduction and other benefits is usually
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easy part I have done enough of these I
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know when I send in this application
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asking for the guaranteed-issue for the
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essentially unknown special 15%
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California law that the application is
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gonna be denied I even sent it in with a
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copy of the California law this is why I
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bookmarked this page on my computer but
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I know the insurance company that we
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choose will deny the application and I
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will have to fight them the insurance
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companies hate accepting Medicare
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supplement policies guaranteed-issue the
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reason being the insurance company knows
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if a person is applying guaranteed-issue
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they have certain medical problems that
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would normally deny them and in turn the
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insurance company knows this person will
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likely incur many claims and the
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insurance company will likely payout far
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more money than it brings in when I send
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in the application for my client I
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prepare them that this will get denied
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and what it does we will have to do a
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3-way phone call between my client
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myself and the insurance company and the
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phone call will likely take at least two
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hours and will be passed around to many
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different people also I informed my
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client that our goal is to find someone
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that is willing to take all the
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information we provide up to an upper
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manager because usually the manager will
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say to us there is no such law what
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happens is the insurance company does
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business all over the nation and this
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15% rule is only in California I have
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searched everywhere that I know all over
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Medicare's official websites every
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Medicare document I know and very few
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companies actually have the rule in
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their underwriting guide the
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underwriting guide is the underwriting
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team's Bible at the insurance company if
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it isn't in the guide that it doesn't
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exist to them so what ends up happening
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is on our phone call we bounced around
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and get sent to a manager
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kindly tells me I don't know what I'm
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talking about and there is no such law
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and most of the time I'm able to keep my
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cool but sometimes it does get a little
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heated last we finally get to someone
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who has the ear of someone in upper
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management we're told they're not
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available but they will take all the
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information to them usually about 24
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hours later my client gets a call and
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it's not from me he comes from the
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insurance company at their agent was
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ultimately correct about this law and
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they've never heard of it and they will
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be issued coverage as if they had no
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medical conditions whatsoever
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this means no increase of premiums for
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having certain medical conditions and no
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pre-existing condition waiting periods
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as well if you have any questions about
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this rule or any other question about
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Medicare in general we're here to help
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we help with Medicare supplement plans
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Medicare Advantage Part C plans Part D
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prescription drug plans protecting
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retirees retirement and much more again
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I'm Chris Duncan and it's easy to
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contact us you can do so toll-free at
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800-909-9441
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