Call today to eliminate the confusion. This page, highlights the — correct steps for when & how to — take action:
Some background on MediCare:
When you sign up and are covered it is important to understand — MediCaare does not pay 100% for each outpatient treatment expense.
What to do about the part of your treatment expenses MediCare does not pay?
Buy from private companies either of these types of plans, which work with MediCare!!
● Details on one type — a Medicare Advantage Plan are on this page How they work and what you gain.
● Details on the second type — a Medicare Supplement approved for CT are on this page How they work and what you gain.
Quick answer — nothing unless you want to sign up!
● Social Security (SS) not MediCare is responsible for the eligibility & enrollment regulations — I like to call them rules.
-> a person becomes what MediCare calls — "eligible" for coverage the month when 65. .
Key — you do not have to sign up at 65!
Note: Individuals under 65 and receiving Social Security disability also are eligible after 24 months.
Key — most importantly SS - processes a person's applications so I recommend calling the Local SS office:
-> ask to speak with or for a time to call a retirement person.
Note: The MediCare system considers you "entitled" — when your application is complete. It's their name for the date your coverage began:
-> Part A for inpatient hospital services.
-> Part B for medically necessary outpatient services.
BTW — entitled is an important MediCare word - its printed on each ID card above Part A and Part B to show when the person's coverage started!
The IEP is a seven month period with the person's eligible month in the middle.
Want to sign up at 65? You can submit your application for Part A & Part B during:
● Any of the three months before eligible. If you do you will be considered entitled (covered) for both Part A & Part B the first day of your eligible month.
Note: Eligible month is moved to the previous one when a birthday is on the 1st.
● The eligible month or in any of the three months after. If you sign up during this time it results in:
-> Part A always being the first of their eligible month.
-> Part B having different dates! Why? Rules say B's effective date is determined by the date you apply. If sign up the:
+ Month when 65 it will be the next month.
+ Month after 65 it will be two months after.
+ Second or third month after 65 it will be three months after.
SS's complex [not logical ] rule when a person signs up the last month of the IEP means Part B is - six months after A.
Note: SS also decided — Part A will be backdated six months from the date of a Person's Part B for — everyone who signs up more than six months after eligible!
The most common SEP is when a person was working past 65 then decides to sign up for Medicare's Part B.
First the when — SEP rules say a person - working past 65 - can sign up anytime. - IF covered by an employer plan. Than their SEP:
● Can begin, whichever is first, the month after:
-> employment or
-> employer coverage ends
If apply while on the employer plan:
● Part B can start the:
-> First of any of the following three months.
If apply after leaving Part B can start
● Back to the first of the month if apply during the month after leaving – thus no days without coverage.
● First of the next month if apply in any of remaining eight months of their SEP:
Second the how to — sign up:
Call the Local Social Security office to talk to or for a time to call a Retirement person about:
-> Completing the Part B application.
-> 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.
● Returning the CMS-L564 means the person:
-> qualifies for the Part B SEP.
-> will not have to pay a late enrollment penalty.
Note: If proof of prior coverage is not available - an additional 10% is added to Part B's cost for each 12 months after eligible.
● You can also get the sign up forms on this link – down the page there is a Section - Already enrolled in Medicare. It includes a link to the Part B sign up form CMS-40B and the – CMS L564 form to show you have coverage.
Alert - Signing up after 65 means Part A will be activated back six months from the date entitled to B! So HSA contributions must stop six months before Part B's date.
The GEP is available for the person who, for some reason, did not apply during their IEP nor had a life situation change to qualify for a SEP
The GEP has special rules for when the person can apply and for when they will become 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! If a GEP has to be used what medical treatment coverage is available?
When a GEP is being used you can:
● Activate Part A [done anytime ] and have coverage for any hospital situations.
-> When 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.
The disadvantage when a GEP is used — you have to wait for outpatient treatment until July 1st. Thus, would have to pay what MediCare considers the assigned amount if any is needed
You can also send a note — Learn@JohnCParker.agency