Can someone explain the deadlines to sign up and the # of changes allowed?

Jul 3, 2007

  1. trvlnut
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    trvlnut Super Genius

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    I have been reading a lot about the Medicare plans and I am pretty confused. If I understand correctly, when a person can sign up for Medicare between 65 and 65 1/2. If they have a group policy, they can wait until they no longer work for the employer to sign up.

    Once signed up, the person can make one change and then he or she is locked in forever, correct?

    Medicare Advantage plans replace Medicare and are free? They work like a regular individual insurance plan. There are OOP max's.

    Please feel free to add anything else that I am totally off base about.
     
    trvlnut, Jul 3, 2007
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  2. AZagent
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    AZagent Expert

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    [imgreflect]
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    Typically an individual can sign up with a plan 3 months before their 65th B-Day & 3 months after their B-Day.

    You are correct about the group employer plan info.

    Now when an individual enrolls into a MA plan the rules are as follow:

    Nov. 15th - Dec. 31st of every year is an Open Enrollment period where an individual can enroll into whatever MA plan they want to.

    Jan. 1st - Mar. 31st of every year You can also join or switch Medicare plans (only once though).

    Jan. 1st - Dec.31st anyone can enroll into a Special Needs MA Plan.

    There is a lock in period that begins April 1st of every year. Medicare recipients are never locked in to a plan for life only from Apr. 1st - Nov.15th. Unless of course if they move from a MA plan to a SNP.

    Medicare recipients who join a MA plan still have their medicare, and have to continue to have parts A & B to even be enrolled into a MA plan. However once enrolled into a MA plan, the private company that they have chosen will be their primary & only payor for Health Bills.

    There are Out of Pocket Max's on MA plans and they vary from plan to plan. There are also MA plans with premiums & they can range from $0.00 - $50.00+ If you go to Medicares website www.medicare.gov you can probably find out all you need to know about Medicare and MAs
     
    Last edited: Jul 3, 2007
    AZagent, Jul 3, 2007
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  3. senior-advisor-indiana
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    senior-advisor-indiana Guru

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    It doesn't matter if someone has group coverage, they still get medicare A at 65. If their B-day is on the 1st of the month then thier medicare A starts the month priorThey should not pick up B if they continue thier employer plan.
     
  4. michellea
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    michellea Super Genius

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    In regards to the lock in period, there are exceptions for certain people and they can enroll in a MA Plan during the lock in. They are:

    3 months before and after the 65th birthday.

    In the state of Alabama if their income for a single individual is less then around 1200 and if a couple's income is less then around $1500 then they can enroll. (if they are dual eligible)

    If they drop group coverage even if they are not dual eligible they can enroll during the lock in period.

    If they are not "dual" eligible but LIS (low income subsidy) eligible they can enroll.

    and

    If they are not dual eligible but wish to enroll without drug coverage then they can enroll in a MA plan during the lock in period.

    I am new to this as well and I did not think I would ever figure it out, every time I thought I understood it I would learn new information!

    I started this job thinking it was going to be a "quick easy" way to make money but learned quick that it was not as "easy" as I thought it would be. Luckily for me, I really enjoy my new career and I am up for all the research and constant learning that is involved in this business.

    If I left out any other ways someone can enroll during the lock in period please let me know!
     
  5. senior-advisor-indiana
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    senior-advisor-indiana Guru

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    You just said the same thing that AZ said except you made it sound alot more complicated.
     
  6. michellea
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    michellea Super Genius

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    I was only speaking in terms of the lock in period, which AZ did not specify that you can enroll people during that time, so I was discussing the enrollment rules during lock in only. Sorry, I guess I did repeat some of what he said, but some of what I said had not been discussed.
     
  7. senior-advisor-indiana
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    senior-advisor-indiana Guru

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    I see he did not mention the enrollment for mar 31- nov 15. The LOEP. Where anyone that has not been enrolled in a MA before can switch from medicare to an MA. That is only suppose to be untilll the end of 2008 though.

    Anyone who is on medicare and medicaid can enroll in the SNP at anytime. Dual eligible is when they are on medicaid and medicare both. ( I know you know that but it is for the original poster).

    Also if it is the first time that someone enrolled in a medicare advantage plan, they have 12 months in which they can switch back to original medicare at any time. After that 12 month period is when their actual lock in period begins.
     
  8. Frank Stastny
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    When someone turns 65 they automatically receive Medicare Part A regardless if they are still working. Medicare Part B is optional even though Medicare sends the card with them already enrolled in Medicare Part B. They can decline that coverage and should if they are still working and want to continue to be covered by their group insurance. (Not a good decision in most cases.)

    Medicare Open Enrollment lasts for six months. It is the first six months after the effective date of Medicare Part B. It is not three months before and three months after they receive Medicare Part B. The Open Enrollment period only relates to the effective date of Medicare Part B.

    Insurance companies will let agents write Medicare Supplement policies three months in advance of date of the person's effective date of Part B, but this is not a part of their "Open Enrollment" period.

    If a person turns 65, does not take Part B and is not covered by a group plan that person will pay a penalty if they decide to take Part B at a later date.
     
  9. Frank Stastny
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    Frank Stastny Guru

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    No. If a person takes a Medicare Supplement policy that person can change policies and or carriers every month, twelve months a year, if they want to. There are no restrictions except after their Open Enrollment period, the first six months after the effective date of Part B, they will have to answer health questions on the application.

    I think it is way too confusing to discuss both PFFS plans and Medicare Supplement policies in the same thread, especially for someone who is new to the senior market. Or at least specifically identify the type of plan you are giving information about.

    Another thing that I believe is very confusing is when agents are talking about PFFS plans and refer to them as Advantage Plans. There are many Advantage Plans, PFFS is only one of them and the one that has the most restrictions.

    I think all of us would be better served if agents, when talking about PFFS plans, would refer to them as PFFS plans and not just as "Advantage Plans".
     
  10. InsuranceJosh
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    InsuranceJosh Super Genius

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    Let me make this clear. Medicare's open enrollment last for 7 months. 3 months before your b-day, the month of your b-day and 3 motnhs after your b-day... This is the enrollment to get on Medicare A and B.
    Now the open enrollment for Medicare Supplements last for 6 months after they get on part B.

    All the medicare supplement copanies I have ever done policies with let me write 6 Months before the effective date of part B.
     
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