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That was from a comment I made to Vic because I can't hold all the factors of a case in my mind at once, and his response.
I have gone for more discussion clarification, at least for me, in a post above.
Can Some one enroll into Medicare when
- Thread starter vic120
- Start date
I have gone for more discussion clarification, at least for me, in a post above.
- 7,073
So does QLE mean a timeframe where the employee could leave the plan without being subject to employer plan restrictions allowing dropping the plan only at annual enrollment?
There are many rules at play here . . . some are government initiated, some are carrier rules.
There are no late enrollment penalties or timelines for enrolling in Part A. If you enroll in Part A after 65 your effective date will be the earlier of 6 months from the date you apply for Part A or your 65th birthday.
Part B is a bit more complicated. The B application is a paper app (you may be eligible to use the e-form), either way the form is CMS-40b.
If you are applying during an SEP, you should submit form L-564 along with your 40b application to avoid any late fees.
Leaving EGH is another wrinkle since some plans only allow you to voluntarily leave at age 65 or during the annual enrollment. You may also leave if you have a LQE as recognized by the plan sponsor.
Primary QLE (Qualifying Life Even) includes loss of health insurance coverage, change in household (marriage, divorce, etc.), relocation to a different zip or county. In addition there are a host of other QLE's including release from prison, becoming a member of a recognized tribe, becoming a US citizen . . .
Additionally, Medicare has their own rules with regard to enrolling/changing your MAPD or PDP.
www.medicare.gov
There are no late enrollment penalties or timelines for enrolling in Part A. If you enroll in Part A after 65 your effective date will be the earlier of 6 months from the date you apply for Part A or your 65th birthday.
Part B is a bit more complicated. The B application is a paper app (you may be eligible to use the e-form), either way the form is CMS-40b.
If you are applying during an SEP, you should submit form L-564 along with your 40b application to avoid any late fees.
Leaving EGH is another wrinkle since some plans only allow you to voluntarily leave at age 65 or during the annual enrollment. You may also leave if you have a LQE as recognized by the plan sponsor.
Primary QLE (Qualifying Life Even) includes loss of health insurance coverage, change in household (marriage, divorce, etc.), relocation to a different zip or county. In addition there are a host of other QLE's including release from prison, becoming a member of a recognized tribe, becoming a US citizen . . .
Additionally, Medicare has their own rules with regard to enrolling/changing your MAPD or PDP.
Special Enrollment Periods
You can make changes to your Medicare Advantage and Medicare drug coverage when certain events happen in your life, like if you move or you lose other coverage.
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Again, I'd have to dig for this as it's been some time, but I think IRS clarified "eligibility" as not just being able to obtain but actually enrolled in it. I believe this had to do with COBRA issues years back.
Yes, you are first eligible the time you are 65, but with current SEP guidelines you are eligible to enroll into Medicare "During any month you remain covered under the group health plan and your, or your spouse's, current employment continues".
Upon enrolling into Medicare based on the SEP eligibility, that should give you the right to cancel your EGC. I have never had an issue with someone 65+ cancelling their EGC after enrolling into Medicare. It's not about "first" eligibility.
Think about it this way... anyone who's 65 is eligible to enroll. If IEP passes, they are not eligible to enroll. An SEP/GEP makes them eligible again. Its less about meeting the age criteria of being capable of obtaining Medicare, but more about the event that occurs that makes them eligible to enroll into Medicare (IEP, SEP, GEP).
selfgen
Guru
Why wouldn't there be a SEP for a PDP if he dropped group coverage? What am I not understanding?
- Thread starter
- #26
Something must have changed I dont know
If I still had the old UHC SEP book we all used to work off of
but loss of group while still working however it was worded was SEP with MA MAPD but not PDP
Maybe it changed but this was they way it was at one one at least 2014 15 or 16 when it used to come up more and we used to work out of these manuals
there was a difrence, I remember being confused by it and checked into it
The PDFs would be all sectioned for MA MAPD and PDP and there were differences on several things otherwise it would not be sectioned
- Thread starter
- #27
and I am only guessing it changed based on the responses
But I do remember retiring was SEP for Both but when you kept working this was not an sep for PDP but it was for MA, MAPD
I don't have any books anymore, as the online apps have all the seps right on it
and it would make sense if they just simplified that
but that is the way it used to be for sure
Loss of creditable coverage may or may not create an SEP but it does start the LEP clock . . .
The late enrollment penalty is an amount that can be added to your Medicare drug coverage (Part D) premium. You may have to pay a late enrollment penalty if at any time after your Initial Enrollment Period is over, there's a period of 63 or more days in a row when you don't have Medicare drug coverage or other creditable prescription drug coverage.
www.medicare.gov
The late enrollment penalty is an amount that can be added to your Medicare drug coverage (Part D) premium. You may have to pay a late enrollment penalty if at any time after your Initial Enrollment Period is over, there's a period of 63 or more days in a row when you don't have Medicare drug coverage or other creditable prescription drug coverage.
Part D late enrollment penalty
The cost of the Part D late enrollment penalty, which is determined based on how long you are without creditable prescription drug coverage
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One thing I think I just learned while looking at this is:
The availability of the Leaving Employer Coverage SEP and the assessment of a Part D LEP when using it are two different things.
Two people leaving employer coverage (retiring or not) might legitimately use the SEP, but one could be assessed a Part D LEP and the other not.
The availability of the Leaving Employer Coverage SEP and the assessment of a Part D LEP when using it are two different things.
Two people leaving employer coverage (retiring or not) might legitimately use the SEP, but one could be assessed a Part D LEP and the other not.
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I just stumbled on a 2018 version of UHC book on an IMO website. No guarantee about how long it might be available.
And with the title clues, I also just found one for 2016:
And 2021/2022
(don't seem to be able to get anything later)
And with the title clues, I also just found one for 2016:
And 2021/2022
(don't seem to be able to get anything later)
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