Applying for MediCare

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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:

First – reaching 65 and becoming "eligible"

  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:

Initial Eligibility Period (IEP)

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.

Special Enrollment Period (SEP)

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. 


General Enrollment Period (GEP)

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.


Do you have sign up questions on Medicare or Medicare Health Plans? Send me a note..

Feel free to contact - Learn@JohnCParker.agency