People report much of the online information they found on who should sign up for MediCare and when is confusing!
Even some of the Social Security [responsible for enrollment] information found online is not up to date!
What to do? I receive lots of what to do and when questions so want to share the proper steps to apply for the federal MediCare program:
● The Medicare system considers a person eligible the month they turn 65.
Note: A person who qualified for Social Security disability and is under 65 also becomes eligible after receiving benefits for 24 months.
[They have until month 28 to decide what to do.]
● Social Security (SS) not MediCare establishes eligibility.
Note: When a person's application is complete MediCare considers them entitled. Their ID card will show entitled above the date they were covered by:
> Part A for inpatient hospital services.
> Part B for medically necessary outpatient services.
Federal regulations limit the times to apply for MediCare to the eligibility periods shown below:
A person is considered eligible the month they will be 65.
Note: If a person’s birthday is the 1st day of a month coverage begins the first day of the previous month.
If they decide to apply during their seven month IEP sign up can be completed through Social Security - during:
● Either of the three months before eligible. Part A & B coverage will then be effective the first of their eligible month.
● The month of becoming 65 and any remaining month of their IEP:
> Part A will always be effective the first day of their eligible month.
> Part B's effective date is calculated from the date they apply. Coverage will begin the first of the:
+ Next month if sign up the month when 65.
+ Second month after if apply in the month after 65.
+ Third month after if apply during second or third month after 65.
Note: Person signing up three months after 65 has Part B six months after their Part A.
A SEP is a special time for individuals who worked past age 65 to apply for Part B and not pay a penalty.
The rules for a Person to qualify for and use a SEP are:
● They can apply at anytime when covered by an employer medical plan.
● Leaving employer coverage creates an eight month period to sign up. It begins the month after employment ends or employer coverage ends whichever is first.
● If they apply when still on the employer plan or in the first month after leaving this coverage Part B will be effective either:
> The first of the month they enroll – thus no days without coverage.
> Their choice of the first of any of the following three months
● If apply in any remaining months of their SEP Part B will start the first of the next month.
The rules for what a Person has to do to qualify for a Part B SEP when leaving employer coverage after 65.
First - Calling the Local Social Security office for an appointment with a Retirement person is important because they need to:
● Ask for Form CMS-L564.
● Take the form to your employer to fill in the dates covered by the company medical benefit plan, get it signed, and take it back to the SS office.
● This proof of prior coverage qualifies a person to sign up and eliminates B's late enrollment penalty.
Note: If no proof - an additional 10% is added to Part B's cost for each 12 months of not signing up.
The effective date rules when a Person applies after 65 - SS activates Part A and makes it effective retroactive six months from the date they receive for Part B.
Alert - if enrolled in an employer's HSA this means contributions must stop 6 months before the date they elect for Part B coverage.
The GEP is available for a person who did not apply for Part D during their IEP or did not have a life change situation to qualify for a SEP.
The GEP is a three month time to sign up with special rules:
● An application for Part B can only be completed once a year between Jan 1st and March 31st.
● When apply during this time B's effective date will not be until July 1st!
● What coverage would a person in this situation have:
> Part A [it can be activated anytime ] and:
> Part D - can sign up for a Medicare Prescription Drug Plan since they have Part A so will have medication coverage.
> Will not have any MD or outpatient treatment coverage.
Feel free to contact - Learn@JohnCParker.agency
The Medicare-Health-Plans-Southeastern-CT content is © 2018 to 2019 by John C Parker, RHU, LTCP - All Rights Reserved.
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