To eliminate confusion I am pleased to:
● Highlight the — when to take action & the correct steps in the sections of this page:
When sign up is complete it is important to understand — MediCaare does not pay 100% of outpatient treatment costs.
To protect your income & savings from the part of your treatment MediCare does not pay I am pleased to provide two ways to pick up the unpaid part:
● Buy a Medicare Advantage Plans in SE CT. There is info on this page on how they work and what you gain.
● Buy a Medicare Supplements. This page has info on how they work and what you gain.
Quick answer — nothing!
● Rules say a person becomes what MediCare considers — "eligible" to sign up for coverage the month when 65. It will start on the first1
Key — you do not have to sign up!
Note: Individuals under 65 who are receiving Social Security disability also are eligible after 24 months.
Key — Social Security (SS) not MediCare sets eligibility rules and most importantly - they process a person's applications.
I recommend calling the Local SS office and ask for a time to call a retirement person.
Note: When your application is complete — MediCare considers you "entitled" for coverage with:
-> Part A for inpatient hospital services.
-> Part B for medically necessary outpatient services.
BTW — entitled is printed on each MediCare ID card above Part A and Part B.
The IEP is a seven month period on both sides of the month a person is eligible.
You can contact SS and sign up for Part A & Part B during:
● Any of the three months before eligible. If so you are entitled the first day of your eligible month.
Note: If birthday is the 1st day of a month you become eligible the first of the previous month.
● The month eligible or in any of the three months after.
● Signing up in any of these months results in:
-> being entitled to Part A the first of the month eligible.
-> being entitled to Part B on various dates determined by the date you applied. It will be the first of the:
+ Next month if sign up in month when 65.
+ Second month after if sign up in the month after 65.
+ Third month after if sign up in second or third month after 65.
This complex [not logical ] rule SS uses when signing up the last month of a person's IEP results in them being entitled to B - six months after A.
Note: The rule saying — A will be back six months from B — is also applied to anyone who signs up for B more than six months after eligible!
The SEP allows a person over 65 who is working, and covered by an employer plan, to sign up for Medicare's Part B.
Note: If qualified for a SEP they do not have to pay a late enrollment penalty.
First — The rules say - someone working and covered by an employer plan, can apply anytime. When a SEP is used:
● The time to sign up begins, whichever is first, the month after:
-> employment ends or
-> employer coverage ends
● There is eight-months to start Part B.
When will a persons coverage start?
● When still on the employer plan they can decide to start Part B either the:
-> First of any of the following three months.
● The first month after leaving Part B can start the:
-> First of that month – thus no days without coverage.
● In any remaining month of their SEP:
-> Part B will start the first of the next month.
Second — how to make sign up happen:
Call the Local Social Security office for a time to call a Retirement person about:
-> How to start Part B.
-> Options to pay your share of the monthly cost of Part B
-> Getting Form CMS-L564. Your employer fills in dates covered by the medical benefit plan and signs.
Note: SS offices are closed so an online way to sign up when leaving an employer was announced May 28, 2020.
● When a CMS-L564 is signed and returned to the SS office the person:
-> qualifies for the Part B SEP.
-> will not have to pay a late enrollment penalty.
Note: If proof of prior coverage was not available - an additional 10% is added to Part B's cost for each 12 months after eligible.
Alert - Part A is activated back six months from the date entitled to B so if enrolled in an employer's HSA contributions must stop six months before Part B's date.
The GEP provides a person, who did not apply during their IEP nor had a situation which qualified for a SEP, to have a time to sign up for Part B
The GEP has special rules on dates to sign up and for when they will be entitled to Part B:
● An application can only be submitted to SS between Jan 1st and March 31st.
● If submitted during this period the person will not be entitled to Part B until July 1st!
OK! I had to use a GEP what medical treatment coverage is available?
● Activate Part A [done anytime ] and have coverage for any hospital situations.
● If A was just activated you can sign up for a Medicare Prescription Drug Plan and have coverage for medications.
● If A was previously effective the start of Part D's medication coverage will also have to wait to July 1st.
However, when a GEP is used you would be responsible to pay what MediCare considers the assigned amount for any needed outpatient treatment until July 1st.
You can also send a note — Learn@JohnCParker.agency
Content on Medicare-Health-Plans-Southeastern-CT is © 2018 to 2020 by John C Parker, RHU, LTCP - All Rights Reserved.
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