Avoiding PDP LEP in 2017

Aug 18, 2016

  1. somarco
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    somarco GA Medicare Expert

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    Lady, age 64, on SSDI and just qualified for Medicare. Does not have creditable Rx coverage now. T65 July 2017.

    I assume she will incur an Rx penalty now but what happens next July when she can get an age-in Medigap plan (no health questions). Does turning 65 grant her a chance to change her PDP if she wants? If so, does the LEP go away when/if she does change plans?
     
    somarco, Aug 18, 2016
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  2. TN_agent
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    TN_agent Guru

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    Why doesn't she sign up for a PDP or MAPD plan now if she just got her Medicare eligibility? Does her income make her eligible for extra help if she missed her window?

    I read on Medicare.gov that she WILL be able to switch to a PDP when she T65 and presumably goes on a supplement. (during what would have been her original IEP had she not gone on Medicare early). I have not run across this personally because most U65 on Medicare I run into are either just going on so we sign them up for PDP/MAPD, covered on a spouse's insurance or are eligible for Extra help so they can change PDP whenever.
     
    TN_agent, Aug 18, 2016
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  3. WCMason
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    WCMason Guru

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    She gets a second IEP and all the options available to her that any age-in gets, including OE on med sup, choosing a new Rx, and all previous penalties go away.
     
    WCMason, Aug 18, 2016
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  4. yorkriver1
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    Can't find reference on Medicare.gov yet, but two Medicare info sites say the same thing: At 65, those on SSDI get a second open enrollment same as anyone else T65. They don't have to prove they had creditable coverage to avoid the penalty. So, option to enroll in PDP 3 months before, month of, then 3 months after T65, avoid penalty.

    Last one of these I did, PDP carriers code for enrollment: IEP II, but best to confirm that.
     
  5. somarco
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    somarco GA Medicare Expert

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    Thx WCM and York. Pretty much as I thought it would be but this is an unusual situation (for me at least).

    TN Agent. She wants to keep her docs. Lives in rural area and MA HMO plans don't work for her. Still in her initial enrollment period but the catch is no prior creditable Rx coverage.

    Have not explored extra help with her. Trying to walk her through the buy a plan now and a different plan in 11 months without confusing her too much.
     
    somarco, Aug 18, 2016
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  6. TN_agent
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    I don't think it matters if she has had prior RX coverage or not, this is the first time she has been eligible for a Medicare Part D.

    Based on my understanding, she could have gone the last 10 years without medical insurance of any kind and she will not be charged an LEP if you just sign her up for PDP now during her IEP (with original Medicare since she doesn't want an MAPD). The late enrollment penalty doesn't start until she has gone without creditable coverage more than 63 days after her IEP ends.

    https://www.medicare.gov/part-d/costs/penalty/part-d-late-enrollment-penalty.html
     
    TN_agent, Aug 18, 2016
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  7. somarco
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    somarco GA Medicare Expert

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    Ah, no LEP now. Got it. Too many things going on now. This forum can be so helpful. Thanks.
     
    somarco, Aug 18, 2016
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