I had a call with an agent and this issue can be confusing, so I thought I’d blog about this so that everyone can benefit from this. In cases where a Medicare Beneficiary defers their Part B (due to the ACTIVE EMPLOYMENT) of Self or Spouse, and then enrolls in Part B later when either they retire or their spouse retires, the enrollment period for a Stand Alone Part D plan is NOT the initial enrollment period (IEP).
This is confusing because it would be the Initial Coverage Election Period (ICEP), but this assumes that they would be enrolling in MEDICARE ADVANTAGE!
The reason why this is an “initial” enrollment for MA and NOT an “initial” enrollment for Part D can be explained by the qualifications for each product. . .Part D ONLY requires EITHER Part A or Part B or both. However, MA requires BOTH A and B. So, when a person turns 65 and gets Part A premium free (even if they continue to work), they are qualified for a Part D plan and their IEP begins.
Assuming they have “Creditable Coverage” with their (or spouse’s) employer, they would have a SPECIAL ELECTION PERIOD (EGHP) to enroll in Stand Alone Part D.
The key here is to use the right coding on the application!
I put together a web page which has some information on enrollment periods:
I am trying to see if my son qualifies for slmb or Q-1 but the state says he makes too much money. He receives ssdi and his payroll check. He is in Mead and qualified for Medicare part D. He does have medicare part a but we chose not to buy into part b because he has private health INS through work. We live in NH
Thank you
Janet
Craig,
I want to get back to you on this. I had a customer that I helped in April of this year. He had Part A only since 2001. He declined Part B because of the cost when he became eligible for Part A&B in 2001. I called Social Security April 15 of this year and applied for Part D extra help over the phone with a social security claims rep. I also applied for the state “buy in” in early May 2010 for him because although he was not eligible for full Medicaid or DUAL status he was eligible for the QI 1 or QMB Medicare Savings program. It took awhile but when the state approved his Part B “buy in” or QMB , social security finally had a new Medicare ID issued for him with a Part B effective date retroactive to 5/1/2010.
According to Social Security, this is the only exception to the “general enrollment” period. Its a lot of work for the agent to get this done for a client but its a guaranteed sale if you do all this work to help folks out that declined part B due to cost and didn’t know they were eligible for the state to pay their Part B premium. Starting in 2010 social security is supposed to notify the states about eligibility for Medicare Savings programs if a person qualifies for Part D extra help. I don’t know if that actually happens so I go to my county assistance office and carry the “buy in” apps around if I run into a situation like this I help the client fill out the form and mail it in to the county assistance office.
Mike
Mike:
That’s great info! Thanks Mike! I’m sure other agents could use this, as well. I run into this at least once a month.
Craig,
The 10% per year penalty is also picked up by the state if they qualify for QMB. I don’t know if the state pays that penalty to Social Security but regardless the Medicare beneficiary doesn’t pay it. Also, this client had no Part D plan when I applied for extra help. Medicare auto assigned him a Part D plan effective 7/1/10 when he first received an award letter for extra help. When he finally got his Medicare card with an A & B effective date, I just moved him into a MAPD for a 7/1/10 effective date. The only thing I couldn’t wrap my head around was why Social Security or Medicare didn’t start his Part D plan until 7/1/10 when he was approved for Part D extra help in May( i thought his Part D would of started in June).
The client had to wait almost two months after receiving extra help to actually get a Part D plan. Maybe it had something to do with the fact he didn’t have a Part D plan when he was approved for extra help? I couldn’t really get an answer from Medicare on that.
Craig,
I am helping a customer apply for the Medicare Part B Medicare Savings Program tomorrow and I was told by a state worker that if approved his Part B will start the following month(June in this example). I’ll post something and let you know if it actually happens. Thanks for the follow up on this subject.
Mike
Craig,
Got a question for you that somewhat relates to this. I know the general open enrollment period for Part B is January 1 to March 31. I have met several people that opted out of Part B(mostly because they didn’t want to pay the premiums) but then decided they wanted it when they started getting alot of bills. I think Medicare reinstates Part B for a July 1 effective date when someone signs up for Part B during this time period. If someone is eligible for extra help or some type of Medicare Savings program and they sign up for Part B during the Jan1 to March 31 period, do they get the Part B the following month, i.e, signed up for Part B March 31 got Part B April 1?
Also, if they are eligible for a Medicare Savings program or LIS can they apply for Part B any time of the year and if approved does the Part B get approved retroactive to the time they applied or the following month from when they are approved.
Mike:
I’m not aware of any exception to the “General Enrollment” for Medicare Part B for those in Medicare Savings or LIS. Those in Medicare Savings do not pay a Part B premium, so I’m thinking the 10%/year penalty would be waived for those folks. I’m not aware of any Special Election periods for Part B specifically for folks who deferred Part B and DIDN’T have appropriate coverage, even if they are LIS.